CPT code 42960: Throat bleeding control, simple control2026 Medicare rate & RVUs in Missouri
Reports straightforward control of bleeding in the oropharynx, commonly after tonsillectomy, when the episode does not require more complex intervention.
CMS doesn’t publish an office rate for 42960 in Missouri.
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
On this page 9 sections
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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $141.94 |
| Metropolitan St. Louis, MO | Unavailable | $142.98 |
| Rest of Missouri | Unavailable | $137.61 |
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.
How the rate is built · 42960
RVUs × geographic indexes × conversion factor
Work2.32
2.32 RVUs× 1.000 GPCI
Practice expense1.67
1.67 RVUs× 1.000 GPCI
Malpractice0.37
0.37 RVUs× 1.000 GPCI
Adjusted RVUs
4.3600
Conversion factor
$33.4009
Medicare rate
$145.63
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42960
42960 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42960
Throat bleeding control, simple control
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 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) | 0 | Not paid without supporting documentation. |
| 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) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42960
Throat bleeding control, simple control
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42960 without 51 · national facility
$145.63
Throat bleeding control, simple control
42960-51 · Second procedure: 50%
$72.82
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%).
42960 compared with similar codes
Compare codes · National
4 codes, side by side
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.
42960 billing questions
How does 42960 differ from 42961?
42960 is for simple control of oropharyngeal bleeding. Use 42961 for complicated control that requires hospitalization.
When is 42962 used instead?
42962 describes complicated oropharyngeal bleeding control that requires a secondary surgical procedure. It is not the simple-control level represented by 42960.
Are packing or cautery separately reported?
When packing or cautery is used as part of controlling the oropharyngeal bleed, it is a method of performing this service. Document the hemostatic work and the bleeding site.
Can modifier 50 be appended for bleeding on both sides?
No. CMS indicates that bilateral adjustment does not apply to this code, so modifier 50 is inappropriate.
Are related follow-up visits included?
Related postoperative visits during the 10-day global period are included in the procedure's payment.
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
Fee sheets · Coming soon
Put 42960 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist