$434.05–$498.61
Both describe pharyngeal abscess drainage, but 42720 is for an intraoral route. Use 42725 when the surgeon reaches the pharynx externally.
On this page
CMS RVU26D · Effective 2026-10-01
42725 Pharyngeal abscess drainage Medicare reimbursement rates in Virginia
Drainage of a pharyngeal abscess through an external approach, reported when the surgeon accesses and treats the collection from outside the pharynx. Compare 42725 office and facility rates across CMS payment localities in Virginia.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 42725 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$685.17–$779.86
2 of 2 localities have a supported rate.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Otolaryngology surgery
About 42725: Pharyngeal abscess drainage, external approach
Drainage of a pharyngeal abscess through an external approach, reported when the surgeon accesses and treats the collection from outside the pharynx.
An otolaryngologist or head and neck surgeon uses an external incision to reach and drain an abscess in the pharynx. This is a surgical treatment for a pharyngeal collection requiring access from outside the throat, commonly performed in a hospital operating room. The operative report should identify the pharyngeal site, the abscess, and the external route used to reach and drain it.
Select this code for the external approach; drainage performed through the mouth is represented by a different code. Document the diagnosis, operative findings, approach, and drainage performed. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 42725
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU12.10 · 57%
- Practice expense (office) RVU7.18 · 34%
- Malpractice RVU1.92 · 9%
137
Medicare services in 2024 · #4622 by national volume
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.
42725 compared with similar codes
Office rates for Virginia, from the same CMS release.
$194.21–$227.19
42700 addresses a peritonsillar abscess. Choose 42725 for an abscess in the pharynx that is drained through an external approach.
$503.44–$592.00
21501 is for a deep abscess in neck or thoracic soft tissues. 42725 is specific to a pharyngeal abscess treated through an external approach.
Compare 42725 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$779.86
Virginia →
Office / nonfacility
Unavailable
Facility
$685.17
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42725 billing questions
How is this code distinguished from 42720?
The access route is the key distinction: 42725 describes external access to the pharyngeal abscess, while 42720 describes an intraoral approach. The operative report should make the route clear.
When would 42700 be more appropriate?
42700 is for drainage of a peritonsillar abscess. Use 42725 for a pharyngeal abscess treated through an external approach, rather than selecting by the general presence of a throat abscess.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only when supporting documentation is provided; team surgery is not permitted.
How should modifier 50 be handled?
Do not use modifier 50 to report bilateral performance for this service. The descriptor and anatomy do not support bilateral adjustment.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,0644270F,,Pt rcvng anti r-viral thxpy,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0654271F,,Pt rcvng anti r-viral thxpy,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,06642720,,I&d absc phrngl ntraorl appr,A,,6.15,6.31,,2.94,,0.91,13.37,10.00,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,06742725,,I&d absc phrngl xtrnl appr,A,,12.10,7.18,NA,7.18,,1.92,21.20,21.20,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0684274F,,Flu immuno admind rcvd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0694276F,,Potent antivir thxpy rxd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0704279F,,Pcp prophylaxis rxd,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00