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See a sample rate comparisonCPT 42806 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Biopsy Nasopharynx Survey
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | 51 - Multiple procedures 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $240.49 national non-facility rate (2026) · View Medicare rates for 42806 |
| Medicaid Fee Schedule | $188.86 median of the 8 states in the free preview · View Medicaid rates for 42806 |
National average reimbursement for CPT 42806 by major payers:
$279.09
$294.80
$317.58
$234.74
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CPT 42806
5 of 25 sample ratesHigher to lower in this preview
Texas Health Harris Methodist Hospital Southwest Fort Worth
$6,245.00Published rateSpokane Valley Ear Nose & Throat Ps, Spokane Valley Ambulatory Surgery Center
Spokane Valley Ear, Nose & Throat, P.S.
$1,500.00Published rateReeves Eye Surgery Center LLC
$1,091.00Published ratePremier Surgery Center Of Santa Maria LLC
Premier Surgery Center Of Santa Maria, Inc.
$496.00Published rateDana Spivey
Deaconess Hospital Inc
$178.00Published rate
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See a sample payer proposalCPT 42806 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42806 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 42806 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 42804-CPT | Moderate | Biopsy; Nasopharynx Visible Lesion Simpl |
| 42806-CPT | Moderate | Biopsy Nasopharynx Survey |
| 42970-CPT | Moderate | Control Of Nasopharyngeal Hemo, Control Of Nasopharyngeal Hemorrhage Primary Or Secondary(Eg Postadenoidectomy) Simple With Posterior Nasal Packs With Or Without Anterior Packsandor Cauterization |
| 42971-CPT | Moderate | Control Nose Throat Bleeding, Control Of Nasopharyngeal Hemorrhage Primary Or Secondary Eg Postadenoidectomy Complicated Requiring Hospitalization |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42806. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42806 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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