42806 Biopsy of upper nose/throat
Also known as: complex pharyngeal biopsy, difficult nasopharyngeal biopsy
Biopsy of the nasopharynx and oropharynx with increased complexity or difficult access technique.
In Plain Language
difficult tissue sample from upper throat; complex throat biopsy
Clinical Context
Used for more challenging nasopharyngeal biopsies requiring specialized technique or equipment. Indicated for lesions in difficult anatomic locations or with limited access.
RVU Breakdown
| Work RVU | 1.59 |
| Total RVU | 1.59 |
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 1.59, this code ranks in the 10th percentile among Surgery codes — 5.0x below the median (8.00). The highest wRVU in this category is 106.19.
Specialties
Frequently Asked Questions
What is CPT code 42806?
CPT 42806 (Biopsy of upper nose/throat) is a Surgery code. Biopsy of the nasopharynx and oropharynx with increased complexity or difficult access technique.
What is the wRVU value for CPT 42806?
The work RVU for CPT 42806 is 1.59. This code is primarily used by Otolaryngology, Head and Neck Surgery. It has a 10-day global period.
When is CPT 42806 used?
Used for more challenging nasopharyngeal biopsies requiring specialized technique or equipment. Indicated for lesions in difficult anatomic locations or with limited access.
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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.