CPT code 42950: Pharyngoplasty, reconstruction of the pharynx2026 Medicare rate & RVUs

Medicare pays $733.15 for 42950 nationally in a facility.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42950 covers

An otolaryngologist or reconstructive surgeon performs pharyngoplasty to reshape or restore tissue in the pharynx. A common clinical setting is treatment of velopharyngeal insufficiency, when inadequate closure between the throat and nasal passage affects speech; the operation may also address a pharyngeal defect requiring reconstruction. The specific technique depends on the anatomy and the reconstructive goal, and the service is typically performed in an operating room.

Report this code for reconstructive work on the pharynx, not a simple repair of a throat wound or an operation directed at the esophagus. The operative report should identify the pharyngeal anatomy treated, the reconstructive work performed, and the indication. This is major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 42950 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42950 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 42950 rate is calculated

Each of 42950’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 42950

42950 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

42950 compared with similar codes

How to choose

42900Pharyngeal repairWound closure

42900 is for repair of a throat wound. Use 42950 when the operative work reconstructs or reshapes pharyngeal tissue.

42225Cleft palate repairSecondary lengthening procedure

42225 identifies secondary cleft palate surgery with a pharyngeal flap. Code 42950 is for pharyngeal reconstruction not captured by that specific cleft-palate service.

42953Throat repairCervical approach

42953 concerns repair involving the throat and esophagus. Code 42950 is directed at reconstruction of the pharynx.

42999Unlisted throat procedurePharynx, adenoids, or tonsils

Use 42950 when the documented pharyngeal reconstruction matches this specific service; 42999 is for an applicable procedure without a specific listed code.

Codes related to 42950

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates