42804 Biopsy of upper nose/throat
Also known as: nasopharyngeal biopsy, oropharyngeal biopsy
Biopsy of the nasopharynx and oropharynx (upper throat regions) tissue sampling.
In Plain Language
tissue sample from upper throat; back of nose and throat biopsy
Clinical Context
Used for evaluation of nasopharyngeal or oropharyngeal lesions. Commonly performed for suspected nasopharyngeal carcinoma, adenoid pathology, or persistent symptoms.
RVU Breakdown
| Work RVU | 1.26 |
| Total RVU | 1.26 |
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 1.26, this code ranks in the 7th percentile among Surgery codes — 6.3x below the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42804?
CPT 42804 (Biopsy of upper nose/throat) is a Surgery code. Biopsy of the nasopharynx and oropharynx (upper throat regions) tissue sampling.
What is the wRVU value for CPT 42804?
The work RVU for CPT 42804 is 1.26. This code is primarily used by Otolaryngology, Head and Neck Surgery. It has a 10-day global period.
When is CPT 42804 used?
Used for evaluation of nasopharyngeal or oropharyngeal lesions. Commonly performed for suspected nasopharyngeal carcinoma, adenoid pathology, or persistent symptoms.
Track This Code in RVU Edge
Log procedures, calculate wRVUs, and benchmark against national data — all in one app.
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.