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CPT 42900: Closure of Wound or Injury of the Pharynx with Sutures

CPT code 42900 denotes the physician-performed closure of a wound or injury of the pharynx using sutures. This code captures a focused surgical repair of pharyngeal mucosa or deeper tissues and is relevant across hospital and ambulatory surgical settings. Nationally, accurate use of CPT code 42900 affects surgical billing, procedure tracking, and quality measurement for otolaryngology and emergency surgical care involving the oropharyngeal region.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines what clinicians and billing staff need to know about coding context, typical sites of service, and where this code appears in clinical workflows. Readers will find benchmarks for utilization and reimbursement patterns, summaries of relevant policy updates affecting surgical coding and coverage, and clinical context on indications and procedural considerations for pharyngeal wound closure.

The report is written for a national audience and focuses on standard coding application, payer coverage considerations, and operational implications for surgical services. Data not available in the input will be noted where applicable.

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Billing Code Overview

CPT code 42900 describes the closure of a wound or injury of the pharynx with sutures performed by a physician. The procedure involves suturing lacerations or surgical defects within the pharyngeal mucosa and supporting tissues to restore integrity and function.

Service type: Surgical wound closure of the pharynx
Typical site of service: Operative suite, ambulatory surgery center, or hospital setting where surgical procedures on the pharynx are performed

Data not available in the input.

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CPT 42900: Closure of Wound or Injury of the Pharynx with Sutures

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Billing Code Overview

Service type: Surgical wound closure of the pharynx
Typical site of service: Operative suite, ambulatory surgery center, or hospital setting where surgical procedures on the pharynx are performed

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult who presents to the Emergency Department or outpatient ENT clinic after sustaining a penetrating or lacerating injury to the oropharynx or hypopharynx (for example, from a toothbrush, bone fragment, glass, or blunt trauma causing mucosal tears). The patient undergoes an initial clinical evaluation including airway assessment, hemodynamic stability check, and focused oropharyngeal examination. Imaging (plain radiographs, CT) is obtained as indicated to exclude retained foreign body, deep space infection, or vascular injury. Local anesthesia with topical spray and/or sedation is administered for comfort. The surgeon performs direct visualization of the pharyngeal wound with a laryngoscope or flexible endoscope, irrigates and debrides devitalized tissue, and closes mucosal and submucosal layers with interrupted sutures to restore integrity and reduce bleeding risk. Hemostasis is confirmed and, if needed, antibiotics and tetanus prophylaxis are provided. Post-procedure instructions include airway precautions, soft diet, analgesia, and follow-up for suture removal or wound re-evaluation.

Coding Specifications

Modifier	Description	When to Use
`00`	Provider-specific or payer use (not a CMS standard modifier)	Use only if a payer requires a specific two-digit code labeled as `00` per their rules.
`11`	Usually reserved or non-standard (some payers use for multiple definitions)	Use only if payer-specific policy maps `11` to normal services; verify payer policy.
`22`	Increased procedural service	When the work is substantially greater than typically required (e.g., extensive pharyngeal laceration requiring layered closure and prolonged time).
`23`	Unusual anesthesia	When general anesthesia services are medically necessary but not planned for the procedure.
`26`	Professional component	Where a separate professional component is billed (rare for `42900`) — use only if splitting professional and technical components applies.
`50`	Bilateral procedure	If identical repair is performed on both sides of a paired structure when payer accepts bilateral billing for this code.
`51`	Multiple procedures	When `42900` is performed in addition to other distinct surgical procedures during the same session.
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned (e.g., attempted closure aborted due to patient instability).
`53`	Discontinued procedure	When the procedure is terminated after initiation; use if closure could not be completed.
`62`	Two surgeons	When two surgeons from different specialties work together as primary surgeons performing distinct parts of the procedure.
`66`	Surgical team	When a surgical team approach is necessary (complex pharyngeal reconstruction requiring multiple surgeons).
`78`	Unplanned return to OR	For a return to the operating room for a related procedure during the postoperative period (e.g., re-exploration for bleeding).
`80`	Assistant surgeon	When a surgical assistant performs part of the procedure and payer allows assistant surgeon billing.
`81`	Minimum assistant	When a minimum assistant is required and reported per payer rules.
`82`	Assistant when qualified resident unavailable	Use when a qualified resident is not available and an assistant is required.

Taxonomy Code	Specialty	Notes
`207Z00000X`	Otolaryngology (ENT)	Most common specialty performing pharyngeal wound closure.
`208000000X`	General Surgery	May perform closure in trauma settings or when throat involvement is part of broader neck trauma.
`207R00000X`	Oral and Maxillofacial Surgery	Performs closures when oropharyngeal trauma is associated with maxillofacial injuries.
`363L00000X`	Emergency Medicine	Performs initial assessment and may perform simple closures in the ED setting prior to ENT follow-up.
`207K00000X`	Plastic and Reconstructive Surgery	Involved when complex reconstruction of pharyngeal tissues is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S10.81XA`	Laceration without foreign body of other part of neck, initial encounter	Pharyngeal mucosal lacerations may be reported under neck laceration codes when site specificity includes pharynx.
`S36.811A`	Laceration of esophagus, initial encounter	Relevant for injuries that extend into the hypopharynx or upper esophagus requiring closure.
`S11.31XA`	Laceration with foreign body of larynx, initial encounter	Penetrating injuries near the pharynx with retained foreign body may require visualization and repair.
`T15.02XA`	Foreign body in pharynx, initial encounter	Presence of foreign body causing mucosal injury and need for removal and closure.
`K13.70`	Mucosal ulceration of oropharynx, unspecified	Chronic or acute mucosal defects that may necessitate surgical closure in select cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42820`	Excision of lesion of tonsil(s) (tonsillectomy), partial or complete, any method	Performed when tonsillar pathology is also present or when access requires concurrent tonsil surgery.
`43257`	Esophagoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing	Used when flexible endoscopic evaluation of the hypopharynx and upper esophagus is needed to assess injury extent.
`31237`	Nasal/sinonasal endoscopy, surgical; with control of hemorrhage, any method	May be used in combined procedures addressing adjacent nasal or nasopharyngeal bleeding.
`31500`	Intubation, endotracheal, emergency procedure	Performed when airway protection is required prior to pharyngeal wound closure.
`99152`	Moderate sedation services provided by the same physician/other qualified health care professional performing the diagnostic or therapeutic service, first 30 minutes	Billed when moderate sedation is administered during closure in office or ED by the same provider (verify payer rules).
`12001`	Simple repair of superficial wounds of face, ears, eyelids, nose, lips; 2.5 cm or less	Not for mucosal pharyngeal repair but listed as related for documentation comparison of repair complexity; use appropriate mucosal code `42900` instead.

CPT 42950: Pharyngeal Reconstructive Surgery, Soft Palate and Pharynx

CPT-42953-PHARYNGEAL-ESOPHAGEAL-JUNCTION-REPAIR

CPT 42953: Repair of Pharyngeal–Esophageal Junction Tear

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	Provider-specific or payer use (not a CMS standard modifier)	Use only if a payer requires a specific two-digit code labeled as `00` per their rules.
`11`	Usually reserved or non-standard (some payers use for multiple definitions)	Use only if payer-specific policy maps `11` to normal services; verify payer policy.
`22`	Increased procedural service	When the work is substantially greater than typically required (e.g., extensive pharyngeal laceration requiring layered closure and prolonged time).
`23`	Unusual anesthesia	When general anesthesia services are medically necessary but not planned for the procedure.
`26`	Professional component	Where a separate professional component is billed (rare for `42900`) — use only if splitting professional and technical components applies.
`50`	Bilateral procedure	If identical repair is performed on both sides of a paired structure when payer accepts bilateral billing for this code.
`51`	Multiple procedures	When `42900` is performed in addition to other distinct surgical procedures during the same session.
`52`	Reduced services	When the procedure is partially reduced or not completed as originally planned (e.g., attempted closure aborted due to patient instability).
`53`	Discontinued procedure	When the procedure is terminated after initiation; use if closure could not be completed.
`62`	Two surgeons	When two surgeons from different specialties work together as primary surgeons performing distinct parts of the procedure.
`66`	Surgical team	When a surgical team approach is necessary (complex pharyngeal reconstruction requiring multiple surgeons).
`78`	Unplanned return to OR	For a return to the operating room for a related procedure during the postoperative period (e.g., re-exploration for bleeding).
`80`	Assistant surgeon	When a surgical assistant performs part of the procedure and payer allows assistant surgeon billing.
`81`	Minimum assistant	When a minimum assistant is required and reported per payer rules.
`82`	Assistant when qualified resident unavailable	Use when a qualified resident is not available and an assistant is required.

Taxonomy Code	Specialty	Notes
`207Z00000X`	Otolaryngology (ENT)	Most common specialty performing pharyngeal wound closure.
`208000000X`	General Surgery	May perform closure in trauma settings or when throat involvement is part of broader neck trauma.
`207R00000X`	Oral and Maxillofacial Surgery	Performs closures when oropharyngeal trauma is associated with maxillofacial injuries.
`363L00000X`	Emergency Medicine	Performs initial assessment and may perform simple closures in the ED setting prior to ENT follow-up.
`207K00000X`	Plastic and Reconstructive Surgery	Involved when complex reconstruction of pharyngeal tissues is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S10.81XA`	Laceration without foreign body of other part of neck, initial encounter	Pharyngeal mucosal lacerations may be reported under neck laceration codes when site specificity includes pharynx.
`S36.811A`	Laceration of esophagus, initial encounter	Relevant for injuries that extend into the hypopharynx or upper esophagus requiring closure.
`S11.31XA`	Laceration with foreign body of larynx, initial encounter	Penetrating injuries near the pharynx with retained foreign body may require visualization and repair.
`T15.02XA`	Foreign body in pharynx, initial encounter	Presence of foreign body causing mucosal injury and need for removal and closure.
`K13.70`	Mucosal ulceration of oropharynx, unspecified	Chronic or acute mucosal defects that may necessitate surgical closure in select cases.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`42820`	Excision of lesion of tonsil(s) (tonsillectomy), partial or complete, any method	Performed when tonsillar pathology is also present or when access requires concurrent tonsil surgery.
`43257`	Esophagoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing	Used when flexible endoscopic evaluation of the hypopharynx and upper esophagus is needed to assess injury extent.
`31237`	Nasal/sinonasal endoscopy, surgical; with control of hemorrhage, any method	May be used in combined procedures addressing adjacent nasal or nasopharyngeal bleeding.
`31500`	Intubation, endotracheal, emergency procedure	Performed when airway protection is required prior to pharyngeal wound closure.
`99152`	Moderate sedation services provided by the same physician/other qualified health care professional performing the diagnostic or therapeutic service, first 30 minutes	Billed when moderate sedation is administered during closure in office or ED by the same provider (verify payer rules).
`12001`	Simple repair of superficial wounds of face, ears, eyelids, nose, lips; 2.5 cm or less	Not for mucosal pharyngeal repair but listed as related for documentation comparison of repair complexity; use appropriate mucosal code `42900` instead.

CPT 42950: Pharyngeal Reconstructive Surgery, Soft Palate and Pharynx

CPT-42953-PHARYNGEAL-ESOPHAGEAL-JUNCTION-REPAIR

CPT 42953: Repair of Pharyngeal–Esophageal Junction Tear

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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CPT 42900: Closure of Wound or Injury of the Pharynx with Sutures

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Billing Code Overview

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CPT 42900: Closure of Wound or Injury of the Pharynx with Sutures

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

CPT 42900: Closure of Wound or Injury of the Pharynx with Sutures

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Billing Code Overview

CPT 42900: Closure of Wound or Injury of the Pharynx with Sutures

Sign up for cpt 42900 policy alerts

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical service does CPT 42900 represent and where is it typically performed?

Which modifiers are commonly applicable to CPT 42900 and when should they be considered?

What related CPT codes should be considered in cases involving pharyngeal wound closure?

Which specialties commonly perform CPT 42900 and how do their roles differ?

What clinical workflow and documentation elements support billing CPT 42900?

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

What clinical service does CPT 42900 represent and where is it typically performed?

Which modifiers are commonly applicable to CPT 42900 and when should they be considered?

What related CPT codes should be considered in cases involving pharyngeal wound closure?

Which specialties commonly perform CPT 42900 and how do their roles differ?

What clinical workflow and documentation elements support billing CPT 42900?

References