CPT code 42960: Throat bleeding control, simple control2026 Medicare rate & RVUs

Medicare pays $145.63 for 42960 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 42960 covers

CPT 42960 covers straightforward control of bleeding from the oropharynx, including bleeding that occurs during or after a throat procedure. A familiar situation is a post-tonsillectomy bleed treated with local hemostasis. An otolaryngologist or other physician managing the bleeding may perform the service in an office, emergency department, or surgical setting. The code describes control of the throat bleeding, not repair of a throat wound.

Select this level when the control is simple; cases requiring hospitalization for complicated bleeding or a secondary surgical procedure fall into different codes. Document the bleeding site, its cause when known, the hemostatic work performed, and the circumstances supporting the level selected. The 10-day global period includes related postoperative visits during that period. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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 42960 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

42960 rates by state

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

How the 42960 rate is calculated

Each of 42960’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 42960

42960 has a 10-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

42960 compared with similar codes

How to choose

42961Hemorrhage controlComplicated, hospitalization required

Choose 42960 for simple oropharyngeal bleeding control. 42961 is for complicated control requiring hospitalization.

42962Throat bleeding controlSecondary surgical intervention

Choose 42962 when complicated oropharyngeal bleeding requires a secondary surgical procedure; 42960 represents simple control.

42970Bleeding controlNasopharyngeal, with packing

42970 addresses posterior nasal bleeding control. Use 42960 when the bleeding site is the oropharynx.

Codes related to 42960

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