CPT code 42955: Pharyngotomy, foreign body exploration2026 Medicare rate & RVUs in Texas
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 doesn’t publish an office rate for 42955 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 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 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 | $716.00 |
| Beaumont, TX | Unavailable | $658.24 |
| Brazoria, TX | Unavailable | $686.87 |
| Dallas, TX | Unavailable | $692.09 |
| Fort Worth, TX | Unavailable | $688.61 |
| Galveston, TX | Unavailable | $689.50 |
| Houston, TX | Unavailable | $710.36 |
| Rest of Texas | Unavailable | $672.76 |
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
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
| 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 · 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.
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%).
42955 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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