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

In South Dakota, Medicare pays $706.54 for 42950 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42950 nationwide

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.

How South Dakota compares for 42950

Across 109 of 109 payment localities, the facility rate for 42950 runs from $653.95 in Arkansas to $931.51 in San Benito County, CA. South Dakota pays $706.54. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42950 rates by state

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

See 42950 in every payment locality

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

Codes related to 42950

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

How 42950 has changed in South Dakota

Price 42950 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Agar
• Agency Village
• Akaska
• Albee
• Alcester
• Alexandria
• Allen

Browse all communities in South Dakota

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