CPT code 42953: Throat repair, cervical approach2026 Medicare rate & RVUs in Texas
Reports operative repair of a pharyngeal or cervical esophageal defect, including repair involving a tracheoesophageal fistula, through a cervical approach.
CMS doesn’t publish an office rate for 42953 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 42953 covers
This operation repairs a defect involving the pharynx or the cervical portion of the esophagus through an incision in the neck. It may include closure of a tracheoesophageal fistula, an abnormal connection between the trachea and esophagus. An otolaryngologist or head and neck surgeon commonly performs the procedure in an operating room; a surgeon managing the esophageal defect may also perform it. The operative report should identify the repaired anatomy, the cervical approach, and whether a fistula was repaired.
Report the code when the documented operation matches this anatomic scope and approach, rather than a wound suture, pharyngeal reconstruction, or esophagoplasty described by another code. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons and team surgery are 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 42953 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $920.56 |
| Beaumont, TX | Unavailable | $842.26 |
| Brazoria, TX | Unavailable | $881.25 |
| Dallas, TX | Unavailable | $887.97 |
| Fort Worth, TX | Unavailable | $883.21 |
| Galveston, TX | Unavailable | $884.62 |
| Houston, TX | Unavailable | $910.79 |
| Rest of Texas | Unavailable | $862.03 |
How the 42953 rate is calculated
Each of 42953’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.
How the rate is built · 42953
RVUs × geographic indexes × conversion factor
Work9.21
9.21 RVUs× 1.000 GPCI
Practice expense16.13
16.13 RVUs× 1.000 GPCI
Malpractice1.43
1.43 RVUs× 1.000 GPCI
Adjusted RVUs
26.7700
Conversion factor
$33.4009
Medicare rate
$894.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42953
42953 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42953
Throat repair, cervical approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42953
Throat repair, cervical approach
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42953 without 51 · national facility
$894.14
Throat repair, cervical approach
42953-51 · Second procedure: 50%
$447.07
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42953 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42900Pharyngeal repairWound closure
- This code concerns repair involving the pharynx or cervical esophagus through a cervical approach. Code 42900 is for repair of a throat wound.
- 42950PharyngoplastyReconstruction of the pharynx
- Code 42950 describes pharyngoplasty. Choose this code when the documented operation is repair involving the pharynx or cervical esophagus, with or without fistula repair.
- 43300Esophageal repairCervical approach, no fistula repair
- Code 43300 is the cervical esophagoplasty comparison. Select the code that matches the documented operation and anatomy rather than choosing solely by the cervical approach.
- 42955PharyngotomyForeign body exploration
- Code 42955 concerns pharyngotomy with exploration or foreign-body removal; this code is for repair of a pharyngeal or cervical esophageal defect.
42953 billing questions
When should this code be chosen instead of a throat-wound repair code?
Use this code for an operative repair involving the pharynx or cervical esophagus through a cervical approach, with or without fistula repair. A repair limited to a throat wound may fit the wound-repair code instead.
How does this differ from cervical esophagoplasty?
Choose based on the operation documented and the code descriptor that fits it. This code encompasses repair involving the pharynx or cervical esophagus, while cervical esophagoplasty is the relevant comparison when the operation is described as esophageal reconstruction.
Is postoperative care billed separately during the global period?
Related postoperative care is included in the 90-day global period, along with the day-before preoperative visit.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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
Show the CMS file lines behind this rate
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