CPT code 42961: Hemorrhage control, complicated, hospitalization required2026 Medicare rate & RVUs in Texas
Reports operative control of complicated oropharyngeal bleeding that requires hospitalization, such as significant post-tonsillectomy hemorrhage requiring surgical hemostasis.
CMS doesn’t publish an office rate for 42961 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 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 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 | $379.13 |
| Beaumont, TX | Unavailable | $356.65 |
| Brazoria, TX | Unavailable | $366.82 |
| Dallas, TX | Unavailable | $369.93 |
| Fort Worth, TX | Unavailable | $368.71 |
| Galveston, TX | Unavailable | $368.45 |
| Houston, TX | Unavailable | $383.46 |
| Rest of Texas | Unavailable | $362.07 |
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
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
| 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 · 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.
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%).
42961 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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