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CPT code 42955: Pharyngotomy, foreign body exploration2026 Medicare rate & RVUs

Reports a surgical opening into the pharynx to explore the area or remove a foreign body when operative access through the throat is required.

CMS RVU26DEffective Oct 1, 2026109 payment localities17 Medicare services in 2024

Medicare pays $696.74 for 42955 nationally in a facility.

Medicare rate · 42955

Pharyngotomy, foreign body exploration

Office or facility?

Work RVUs
7.81
Total RVUs
20.86
Global days
090

National rate · 2026

$696.74

Facility setting, before claim adjustments.

See every locality for 42955 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 42955 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 42955 covers

An otolaryngologist or head-and-neck surgeon uses this service to open the pharynx for operative exploration or removal of a foreign body. It is generally performed in an operating room when the target cannot be managed through a less invasive route. The operative note should identify the pharyngeal site, the reason for opening it, the exploration or removal performed, and the method of closure.

Report 42955 for the pharyngotomy itself, not for repair of a traumatic pharyngeal wound or for reconstructive surgery. Routine closure of the surgical opening is part of the service. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. 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 42955 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

42955 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$630.49
AlaskaUnavailable$835.93
ArizonaUnavailable$678.93
ArkansasUnavailable$622.18
Atlanta, GAUnavailable$711.54
Austin, TXUnavailable$716.00
Bakersfield, CAUnavailable$725.00
Baltimore area, MDUnavailable$738.98
Beaumont, TXUnavailable$658.24
Brazoria, TXUnavailable$686.87

42955 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
42955 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 42955 rate is calculated

Each of 42955’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 · 42955

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.81

7.81 RVUs× 1.000 GPCI

Practice expense11.91

11.91 RVUs× 1.000 GPCI

Malpractice1.14

1.14 RVUs× 1.000 GPCI

Adjusted RVUs

20.8600

Conversion factor

$33.4009

Medicare rate

$696.74

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 42955

42955 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42955

Pharyngotomy, foreign body exploration

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42955

Pharyngotomy, foreign body exploration

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42955 without 51 · national facility

$696.74

Pharyngotomy, foreign body exploration

42955-51 · Second procedure: 50%

$348.37

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%).

When to use modifier 51

42955 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 42955

    Pharyngotomy, foreign body exploration7.81 wRVU

    Not priced

  • 42900

    Pharyngeal repair, wound closure5.16 wRVU

    Not priced

  • 42950

    Pharyngoplasty, reconstruction of the pharynx8.06 wRVU

    Not priced

  • 42953

    Throat repair, cervical approach9.21 wRVU

    Not priced

  • 42960

    Throat bleeding control, simple control2.32 wRVU

    Not priced

How to choose

42900Pharyngeal repairWound closure
42900 is for repair of a pharyngeal wound or injury. Choose 42955 for a planned opening to explore the pharynx or remove a foreign body.
42950PharyngoplastyReconstruction of the pharynx
42950 describes pharyngeal reconstruction. It is not the code for opening the pharynx to explore or remove a foreign body.
42953Throat repairCervical approach
42953 concerns repair involving the pharynx and esophagus. Use 42955 when the operative objective is pharyngeal exploration or foreign-body removal.
42960Throat bleeding controlSimple control
42960 is for control of oropharyngeal bleeding, not for a pharyngotomy performed to explore the pharynx or remove a foreign body.

Codes related to 42955

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

Codes related to 42955
CodeHow it relatesNational office range
Used instead
42900Pharyngeal repair, wound closureRepairs a pharyngeal wound; 42955 instead describes deliberate opening for exploration or foreign-body removal.No office rate
42950Pharyngoplasty, reconstruction of the pharynxFor pharyngeal reconstruction rather than operative exploration or foreign-body removal.No office rate
42999Unlisted throat procedure, pharynx, adenoids, or tonsilsUnlisted pharyngeal procedure code when the documented operation is not represented by a specific code.No office rate

42955 billing questions

When is 42955 appropriate instead of a pharyngeal wound repair code?

Use 42955 when the surgeon deliberately opens the pharynx for exploration or foreign-body removal. A traumatic pharyngeal wound repair is a different operative service.

Can the pharyngotomy closure be billed separately?

No. Routine closure of the surgical opening is part of the pharyngotomy service.

Should modifier 50 be appended for bilateral work?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

Can an assistant surgeon be reported?

CMS permits assistant-at-surgery payment for 42955. Co-surgeons and team surgery are not permitted.

What global care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.

How does the multiple-procedure reduction affect 42955?

For procedures performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.

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
RVUs for 42955PPRRVU2026_Oct_nonQPP.csv, line 5,100 (RVU26D)

Open CMS sourceHow we calculate rates

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