FeeBase
Log inGet started
Menu

Billing code 42900: Pharyngeal repairMedicare rate & RVUs

Reports surgical closure of a wound in the pharynx, such as a traumatic or procedural laceration requiring suture repair.

CMS RVU26DEffective Oct 1, 2026109 payment localities51 Medicare services in 2024

Medicare pays $288.92 for 42900 nationally in a facility.

Medicare rate · 42900

Pharyngeal repair

Swap in your local Medicare rate.

Work RVUs
5.16
Total RVUs
8.65
Global days
010

National rate · 2026

$288.92

Facility setting, before claim adjustments.

See every locality for 42900 → · 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.

On this page 10 sections
  1. Medicare rate
  2. What 42900 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 42900 covers

This service closes a wound in the pharynx with sutures. It is typically performed by an otolaryngologist or another surgeon when a traumatic injury or an operative injury has left pharyngeal tissue requiring repair. The work may take place in a hospital operating room or another setting appropriate to the patient and injury. The record should identify the wound’s location and cause and describe the repair performed.

Report 42900 for wound closure, rather than a reconstructive operation or a procedure whose purpose is control of pharyngeal bleeding. The 10-day global period includes related postoperative visits during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of 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 42900 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

42900 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$266.50
Alaska*Unavailable$369.62
ArizonaUnavailable$282.44
ArkansasUnavailable$263.75
AtlantaUnavailable$296.00
AustinUnavailable$291.66
BakersfieldUnavailable$291.02
Baltimore/Surr. CntysUnavailable$304.35
BeaumontUnavailable$278.91
BrazoriaUnavailable$283.89

42900 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
42900 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 42900 rate is calculated

Each of 42900’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 · 42900

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.16Practice expense 2.73Malpractice 0.76

8.6500 adjusted RVUs×$33.4009 conversion factor=$288.92

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 42900

42900 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42900

Pharyngeal repair

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42900

Pharyngeal repair

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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42900 without 51 · national facility

$288.92

Pharyngeal repair

42900-51 · Second procedure: 50%

$144.46

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

42900 compared with similar codes

Compare codes

42900 vs 42950 vs 42953 vs 42960 vs 42999: national Medicare rates

Swap in your local Medicare rate.

  • 42900
    Pharyngeal repair · 5.16 wRVU
    —
  • 42950
    Pharyngoplasty · 8.06 wRVU
    —
  • 42953
    Throat repair · 9.21 wRVU
    —
  • 42960
    Throat bleeding control · 2.32 wRVU
    —
  • 42999
    · 0 wRVU
    —

How to choose

42950Pharyngoplasty
42900 is for suture closure of a pharyngeal wound. 42950 is used for a reconstructive operation on the pharynx.
42953Throat repair
Choose 42953 when the repair involves the pharynx and esophagus; 42900 describes closure of a pharyngeal wound.
42960Throat bleeding control
42960 addresses control of pharyngeal or nasopharyngeal bleeding. Use 42900 when the service is suturing a pharyngeal wound.
42999Unlisted px phrnx adnd/tnsl
Use 42900 when its wound-closure service fits. 42999 is for a pharyngeal procedure without a more specific listed code.

Codes related to 42900

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

Codes related to 42900
CodeHow it relatesNational office range
Used instead
42950PharyngoplastyFor a reconstructive pharyngeal operation rather than closure of a wound.No office rate
42953Throat repairFor repair involving the pharynx and esophagus, rather than an isolated pharyngeal wound.No office rate
42960Throat bleeding controlFor control of pharyngeal or nasopharyngeal bleeding rather than wound closure.No office rate
42999Unlisted px phrnx adnd/tnslUnlisted option when no specific pharyngeal procedure code describes the service.No office rate

42900 billing questions

When should 42900 be chosen over 42950?

Use 42900 for sutured closure of a pharyngeal wound. Code 42950 describes a reconstructive operation on the pharynx, not routine wound closure.

Does 42900 include related postoperative visits?

Yes. Its 10-day global period includes related postoperative visits during the 10 days after the procedure.

How does the multiple-procedure rule affect 42900?

When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code.

Can an assistant surgeon or co-surgeon be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.

What documentation supports reporting 42900?

Document the pharyngeal wound’s location and cause, and describe the suture repair performed. The record should make clear that the service was wound closure rather than reconstruction or bleeding control.

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 42900PPRRVU2026_Oct_nonQPP.csv, line 5,095 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 42900 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 42900 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →