How Much Does Limited Pharyngectomy Cost?
Also known as: Limited pharyngectomy (CPT 42890)
The total estimated cost of Limited Pharyngectomy (CPT 42890) is $4,217 to $7,908, including hospital fees, anesthesia, and supplies. The surgeon's Medicare fee alone is $1,255.
Total Estimated Cost of Care
This estimate includes hospital facility fees, anesthesia, and supplies .
Procedures Commonly Done Together
These procedures are frequently performed alongside Limited pharyngectomy
How to Reduce Your Cost for Limited pharyngectomy
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (37.58) x CF ($33.40) = $1,255
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Limited pharyngectomy cost?
The Medicare facility rate for Limited pharyngectomy is $1,255. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Limited pharyngectomy cost without insurance?
Without insurance, the cost of Limited pharyngectomy can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Limited pharyngectomy?
Most commercial health insurance plans and Medicare cover Limited pharyngectomy when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.