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CPT code 42961: Hemorrhage control, complicated, hospitalization required2026 Medicare rate & RVUs

Reports operative control of complicated oropharyngeal bleeding that requires hospitalization, such as significant post-tonsillectomy hemorrhage requiring surgical hemostasis.

CMS RVU26DEffective Oct 1, 2026109 payment localities59 Medicare services in 2024

Medicare pays $372.75 for 42961 nationally in a facility.

Medicare rate · 42961

Hemorrhage control, complicated, hospitalization required

Office or facility?

Work RVUs
5.63
Total RVUs
11.16
Global days
090

National rate · 2026

$372.75

Facility setting, before claim adjustments.

See every locality for 42961 →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 42961 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 42961 covers

An otolaryngologist typically reports this service when controlling complicated bleeding from the oropharynx, including significant hemorrhage after tonsillectomy that requires hospitalization. The procedure may involve operative hemostasis, such as cauterizing or ligating the bleeding source. The code level is based on the documented complexity and hospitalization requirement, not simply on the presence of bleeding.

Choose 42961 when the complicated hemorrhage requires hospitalization; 42962 is the sibling code when hospitalization and general anesthesia are required. The record should identify the bleeding site, clinical circumstances, treatment performed, and reason hospitalization was required. This major surgery code includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are reduced to 50%. Bilateral adjustment is not appropriate. 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 42961 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

42961 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$341.20
AlaskaUnavailable$464.71
ArizonaUnavailable$363.93
ArkansasUnavailable$337.29
Atlanta, GAUnavailable$381.34
Austin, TXUnavailable$379.13
Bakersfield, CAUnavailable$380.72
Baltimore area, MDUnavailable$393.74
Beaumont, TXUnavailable$356.65
Brazoria, TXUnavailable$366.82

42961 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
42961 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 42961 rate is calculated

Each of 42961’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 · 42961

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.63

5.63 RVUs× 1.000 GPCI

Practice expense4.71

4.71 RVUs× 1.000 GPCI

Malpractice0.82

0.82 RVUs× 1.000 GPCI

Adjusted RVUs

11.1600

Conversion factor

$33.4009

Medicare rate

$372.75

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

Payment rules and modifiers for 42961

42961 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42961

Hemorrhage control, complicated, hospitalization required

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 · 42961

Hemorrhage control, complicated, hospitalization required

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

42961 without 51 · national facility

$372.75

Hemorrhage control, complicated, hospitalization required

42961-51 · Second procedure: 50%

$186.38

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

42961 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 42961

    Hemorrhage control, complicated, hospitalization required5.63 wRVU

    Not priced

  • 42960

    Throat bleeding control, simple control2.32 wRVU

    Not priced

  • 42962

    Throat bleeding control, secondary surgical intervention7.22 wRVU

    Not priced

  • 42970

    Bleeding control, nasopharyngeal, with packing5.67 wRVU

    Not priced

How to choose

42960Throat bleeding controlSimple control
42960 covers simple control of oropharyngeal hemorrhage. Choose 42961 when the complicated episode requires hospitalization.
42962Throat bleeding controlSecondary surgical intervention
42962 applies when complicated hemorrhage requires hospitalization and general anesthesia; 42961 is for the hospitalization-level service without that added criterion.
42970Bleeding controlNasopharyngeal, with packing
42970 is in the nose/throat hemorrhage-control group. Select based on the applicable bleeding site and procedure rather than treating it as the oropharyngeal hemorrhage code.

Codes related to 42961

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

Codes related to 42961
CodeHow it relatesNational office range
Same family
42960Throat bleeding control, simple controlSibling code for simple control of primary or secondary oropharyngeal hemorrhage.No office rate
42962Throat bleeding control, secondary surgical interventionSibling code for complicated hemorrhage requiring hospitalization and general anesthesia.No office rate
Used instead
42970Bleeding control, nasopharyngeal, with packingConsider for hemorrhage control when the bleeding site and service fit its nose or throat code family.No office rate

42961 billing questions

How does 42961 differ from 42960?

42961 is for complicated oropharyngeal hemorrhage requiring hospitalization. Use 42960 for simple control of primary or secondary oropharyngeal hemorrhage.

When is 42962 the better choice?

Use 42962 when the complicated hemorrhage requires both hospitalization and general anesthesia. Document the circumstances supporting those requirements.

What documentation supports 42961?

Document the oropharyngeal bleeding site, the control procedure performed, the complexity of the hemorrhage, and why hospitalization was required.

Should modifier 50 be reported for bilateral bleeding?

No. CMS bilateral adjustment does not apply to 42961, and modifier 50 is inappropriate for this code.

Can an assistant or another surgeon be reported?

An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.

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 42961PPRRVU2026_Oct_nonQPP.csv, line 5,102 (RVU26D)

Open CMS sourceHow we calculate rates

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