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See a sample rate comparisonCPT 42894 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Revision Of Pharyngeal Walls, Resection Of Pharyngeal Wall Requiring Closure With Myocutaneous Or Fasciocutaneous Flap Or Free Muscle Skin Or Fascial Flap With Microvascular Anastomosis
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision 62 - Co-Surgeons |
| Complexity Level | High |
| Medicare Fee Schedule | $2,072.53 national non-facility rate (2026) · View Medicare rates for 42894 |
| Medicaid Fee Schedule | $1,651.425 median of the 8 states in the free preview · View Medicaid rates for 42894 |
National average reimbursement for CPT 42894 by major payers:
$3,141.37
$3,086.09
$3,352.55
$3,775.80
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CPT 42894
5 of 25 sample ratesHigher to lower in this preview
Surgical Caregivers Of Fort Worth LLC, Texas Health Surgery Center Fort Worth Midtown
Surgical Caregivers Of Fort Worth LLC
$6,068.00Published rateBlack Canyon Surgical Center, LLC
$1,173.00Published rateAdvanced Surgery Center Of Tampa, LLC
$983.00Published rateFlorida Endoscopy And Surgery Center, LLC, Florida Endoscopy & Surgery Center
Florida Endoscopy And Surgery Center, LLC
$509.00Published rateSurgicenter Ltd, Bloomberg Eye Center
Surgicenter Ltd
$208.00Published rate
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See a sample payer proposalCPT 42894 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42894 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 42894 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 |
| 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 |
| 42894-CPT | High | Revision Of Pharyngeal Walls, Resection Of Pharyngeal Wall Requiring Closure With Myocutaneous Or Fasciocutaneous Flap Or Free Muscle Skin Or Fascial Flap With Microvascular Anastomosis |
| 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 42894. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42894 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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