Billing code 42808: Pharyngeal lesion treatmentMedicare rate & RVUs in Utah
Excision or destruction of a pharyngeal lesion is reported when an otolaryngologist removes or ablates the lesion rather than obtaining a diagnostic sample alone.
Medicare pays $224.50 for 42808 in the office in Utah (Utah). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 42808 covers
An otolaryngologist reports this service for operative removal or destruction of a lesion in the pharynx, such as a mucosal growth on a pharyngeal wall. The procedure may be performed in an operating room or another procedure setting, using the approach suited to the lesion’s location and the surgeon’s method. Tissue may be submitted for pathology when excision produces a specimen; destruction may leave no specimen.
Choose this code when the service treats the lesion by removing or destroying it, not when the service is limited to diagnostic tissue sampling. Document the lesion’s pharyngeal location, the treatment performed, and the extent of removal or destruction; include pathology details when tissue is sent. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
42808 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $224.50 | $143.50 |
How the 42808 rate is calculated
Each of 42808’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 42808
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.29Practice expense 4.38Malpractice 0.35
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42808
42808 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42808
Pharyngeal lesion treatment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42808
Pharyngeal lesion treatment
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42808 without 51 · national office
$234.47
Pharyngeal lesion treatment
42808-51 · Second procedure: 50%
$117.24
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42808 compared with similar codes
Compare codes
42808 vs 42800 vs 42804 vs 42806 vs 42890: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42800Biopsy
- 42800 describes biopsy of a throat lesion for diagnosis. Use 42808 when the service removes or destroys the lesion rather than sampling it alone.
- 42804Nasopharyngeal biopsy
- 42804 is for biopsy at a nasopharyngeal site. 42808 describes lesion excision or destruction, not diagnostic sampling.
- 42806Nasopharyngeal biopsy
- 42806 is for biopsy at a hypopharyngeal site. Choose 42808 when the service treats the lesion by excision or destruction.
- 42890Pharyngectomy
- 42890 describes a limited pharyngectomy, a more extensive pharyngeal resection. 42808 applies to excision or destruction of a lesion.
42808 billing questions
When should this code be used instead of a pharyngeal biopsy code?
Use this code when the lesion is removed or destroyed as treatment. A biopsy code describes diagnostic tissue sampling rather than lesion treatment.
Can pathology be billed separately when tissue is removed?
The surgeon’s lesion treatment and the pathologist’s examination of submitted tissue are distinct services. This code describes the procedure, not the laboratory examination.
Does modifier 50 apply if lesions are treated on both sides?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard 50% multiple-procedure reduction.
Are assistant surgeons or co-surgeons payable?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery billing are not permitted.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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