42800 Biopsy of throat
Also known as: throat biopsy, pharyngeal biopsy
Biopsy of the pharynx (throat) tissue obtained via transoral approach to establish tissue diagnosis.
In Plain Language
tissue sample from throat; throat tissue biopsy
Clinical Context
Used when suspected pathology in the pharynx requires tissue diagnosis. Common indications include suspected malignancy, persistent ulcers, or inflammatory conditions.
RVU Breakdown
| Work RVU | 1.40 |
| Total RVU | 1.40 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
As a surgical CPT code, proper documentation must include the operative report detailing the procedure performed, patient positioning, approach, findings, and any complications. This code has a 10-day global period — follow-up visits within 10 days of the procedure are included in the reimbursement. Ensure the diagnosis code (ICD-10) supports medical necessity for the procedure.
How This Code Compares
With a work RVU of 1.40, this code ranks in the 8th percentile among Surgery codes — 5.7x below the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42800?
CPT 42800 (Biopsy of throat) is a Surgery code. Biopsy of the pharynx (throat) tissue obtained via transoral approach to establish tissue diagnosis.
What is the wRVU value for CPT 42800?
The work RVU for CPT 42800 is 1.40. This code is primarily used by Otolaryngology, General Surgery. It has a 10-day global period.
When is CPT 42800 used?
Used when suspected pathology in the pharynx requires tissue diagnosis. Common indications include suspected malignancy, persistent ulcers, or inflammatory conditions.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.