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Billing code 42960: Throat bleeding controlMedicare rate & RVUs

Reports straightforward control of bleeding in the oropharynx, commonly after tonsillectomy, when the episode does not require more complex intervention.

CMS RVU26DEffective Oct 1, 2026109 payment localities123 Medicare services in 2024

Medicare pays $145.63 for 42960 nationally in a facility.

Medicare rate · 42960

Throat bleeding control

Swap in your local Medicare rate.

Work RVUs
2.32
Total RVUs
4.36
Global days
010

National rate · 2026

$145.63

Facility setting, before claim adjustments.

See every locality for 42960 → · 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 42960 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 42960 covers

billing code 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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42960 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$133.29
Alaska*Unavailable$182.45
ArizonaUnavailable$142.12
ArkansasUnavailable$131.77
AtlantaUnavailable$149.24
AustinUnavailable$147.61
BakersfieldUnavailable$147.62
Baltimore/Surr. CntysUnavailable$153.87
BeaumontUnavailable$139.73
BrazoriaUnavailable$143.03

42960 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
42960 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 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

Swap in your local Medicare rate.

Work 2.32Practice expense 1.67Malpractice 0.37

4.3600 adjusted RVUs×$33.4009 conversion factor=$145.63

All indexes start 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

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 · 42960

Throat bleeding 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.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

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

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%).

When to use modifier 51

42960 compared with similar codes

Compare codes

42960 vs 42961 vs 42962 vs 42970: national Medicare rates

Swap in your local Medicare rate.

  • 42960
    Throat bleeding control · 2.32 wRVU
    —
  • 42961
    Hemorrhage control · 5.63 wRVU
    —
  • 42962
    Throat bleeding control · 7.22 wRVU
    —
  • 42970
    Bleeding control · 5.67 wRVU
    —

How to choose

42961Hemorrhage control
Choose 42960 for simple oropharyngeal bleeding control. 42961 is for complicated control requiring hospitalization.
42962Throat bleeding control
Choose 42962 when complicated oropharyngeal bleeding requires a secondary surgical procedure; 42960 represents simple control.
42970Bleeding control
42970 addresses posterior nasal bleeding control. Use 42960 when the bleeding site is the oropharynx.

Codes related to 42960

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

Codes related to 42960
CodeHow it relatesNational office range
Same family
42961Hemorrhage controlComplicated oropharyngeal bleeding control requiring hospitalization.No office rate
42962Throat bleeding controlComplicated oropharyngeal bleeding control requiring a secondary surgical procedure.No office rate
Used instead
42970Bleeding controlFor posterior nasal bleeding control, rather than bleeding from the oropharynx.No office rate

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
RVUs for 42960PPRRVU2026_Oct_nonQPP.csv, line 5,101 (RVU26D)

Open CMS sourceHow we calculate rates

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