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

In New Mexico, Medicare pays $365.20 for 42961 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42961 nationwide

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

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.

How New Mexico compares for 42961

Across 109 of 109 payment localities, the facility rate for 42961 runs from $337.29 in Arkansas to $464.71 in Alaska. New Mexico pays $365.20. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42961 rates by state

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

See 42961 in every payment locality

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.

Payment rules and modifiers for 42961

42961 has a 90-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

Codes related to 42961

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

How 42961 has changed in New Mexico

Price 42961 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

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