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See a sample rate comparisonCPT 42809 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.
Remove Fb Pharynx
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 23 - Emergency Room 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service AG - Primary physician |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $214.43 national non-facility rate (2026) · View Medicare rates for 42809 |
| Medicaid Fee Schedule | $167.07 median of the 8 states in the free preview · View Medicaid rates for 42809 |
National average reimbursement for CPT 42809 by major payers:
$237.41
$252.85
$273.09
$316.96
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CPT 42809
5 of 25 sample ratesHigher to lower in this preview
Campus Surgery Center LLC
Campus Surgery Center L P
$2,239.00Published rateChandler Endoscopy Ambulatory Surgery Center, LLC, Chandler Endoscopy Center
$574.00Published rateWebster Ambulatory Sugery Center Lp, Sunset Hills Surgery Center
$381.00Published rateUsc Ambulatory Surgical Center Prof LLC
$225.00Published rateHotchkiss And Katzen Ambulatory Surgical Center, Metro Ambulatory Surgical Center
Hotchkiss And Katzen Ambulatory Surgical Center
$41.00Published rate
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See a sample payer proposalCPT 42809 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42809 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 42809 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 |
|---|---|---|
| 42808-CPT | Moderate | Exc./Dest.;Lesion/Pharynx,Any Method |
| 42809-CPT | Moderate | Remove Fb Pharynx |
| 42892-CPT | High | Revision Of Pharyngeal Walls, Resection Of Lateral Pharyngeal Wall Or Pyriform Sinus Direct Closure By Advancement Of Lateral And Posterior Pharyngeal Walls |
| 42900-CPT | Moderate | Suture Pharynx Wound/Injury |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42809. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42809 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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