# CPT 42800: Biopsy, oropharynx

Medicare CPT 42800 pays $159.66 in a non-facility setting and $106.21 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $141.33 in Arkansas to $186.77 in Alaska, a 32% spread.

Web page: https://www.med-reveal.com/rates/42800-cpt-fee-schedule
Section: Surgery and Procedures

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $159.66 |
| National facility | $106.21 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $186.77 | $129.85 |
| District of Columbia | $181.82 | $118.87 |
| California | $177.53 | $114.29 |
| New York | $176.63 | $117.01 |
| New Jersey | $175.99 | $115.81 |
| Washington | $174.48 | $113.55 |
| Massachusetts | $172.97 | $112.93 |
| Hawaii | $171.21 | $110.45 |
| Connecticut | $170.22 | $112.66 |
| Florida | $166.65 | $113.03 |
| Colorado | $165.46 | $108.60 |
| Maryland | $165.31 | $109.60 |
| Oregon | $163.76 | $107.46 |
| Rhode Island | $163.28 | $108.08 |
| New Hampshire | $163.12 | $107.49 |
| Illinois | $162.64 | $111.00 |
| Puerto Rico | $160.72 | $106.69 |
| Virgin Islands | $160.72 | $106.69 |
| Montana | $159.64 | $106.20 |
| Nevada | $158.59 | $105.10 |
| Pennsylvania | $158.39 | $106.05 |
| Delaware | $157.91 | $105.11 |
| Wyoming | $157.83 | $104.39 |
| Minnesota | $157.79 | $102.80 |
| Texas | $157.77 | $105.16 |
| Georgia | $156.24 | $105.25 |
| Michigan | $156.06 | $105.88 |
| Virginia | $155.79 | $103.26 |
| North Dakota | $155.49 | $102.05 |
| Arizona | $155.36 | $103.58 |
| Vermont | $155.13 | $102.23 |
| South Dakota | $155.00 | $101.56 |
| Utah | $152.59 | $102.35 |
| Maine | $152.32 | $101.26 |
| New Mexico | $152.28 | $103.27 |
| Missouri | $150.83 | $101.79 |
| Louisiana | $150.78 | $101.98 |
| South Carolina | $150.56 | $101.18 |
| Ohio | $150.50 | $101.71 |
| Wisconsin | $150.36 | $99.16 |
| North Carolina | $150.03 | $100.17 |
| West Virginia | $148.81 | $102.37 |
| Indiana | $148.32 | $98.78 |
| Idaho | $147.49 | $98.32 |
| Kentucky | $147.31 | $99.80 |
| Nebraska | $147.14 | $97.81 |
| Tennessee | $146.77 | $98.20 |
| Oklahoma | $146.76 | $99.04 |
| Iowa | $146.43 | $97.53 |
| Kansas | $146.01 | $97.70 |
| Alabama | $143.38 | $96.62 |
| Mississippi | $143.11 | $97.10 |
| Arkansas | $141.33 | $95.42 |

## Related codes

- 31535: Laryngoscopy, direct, with biopsy — https://www.med-reveal.com/rates/31535-cpt-fee-schedule
- 31570: Laryngoscopy with injection into vocal cord(s) — https://www.med-reveal.com/rates/31570-cpt-fee-schedule
- 31575: Laryngoscopy, flexible, diagnostic — https://www.med-reveal.com/rates/31575-cpt-fee-schedule
- 31578: Laryngoscopy with removal of foreign body — https://www.med-reveal.com/rates/31578-cpt-fee-schedule
- 31590: Laryngeal reinnervation — https://www.med-reveal.com/rates/31590-cpt-fee-schedule
- 42410: Excision of parotid tumor or parotid gland, lateral lobe, without nerve dissection — https://www.med-reveal.com/rates/42410-cpt-fee-schedule
- 42420: Excision of parotid gland, total, with dissection of facial nerve — https://www.med-reveal.com/rates/42420-cpt-fee-schedule
- 42440: Excision of submandibular gland — https://www.med-reveal.com/rates/42440-cpt-fee-schedule

Commercial negotiated rates for 42800 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules