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Billing code 42970: Bleeding controlMedicare rate & RVUs

Reports operative control of primary or recurrent bleeding from the nasopharynx when packing is used, including hemorrhage following adenoid surgery.

CMS RVU26DEffective Oct 1, 2026109 payment localities13 Medicare services in 2024

Medicare pays $364.40 for 42970 nationally in a facility.

Medicare rate · 42970

Bleeding control

Swap in your local Medicare rate.

Work RVUs
5.67
Total RVUs
10.91
Global days
090

National rate · 2026

$364.40

Facility setting, before claim adjustments.

See every locality for 42970 → · 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 42970 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 42970 covers

This service controls bleeding in the nasopharynx using packing. It may be needed for primary bleeding or a later hemorrhage, including bleeding after adenoidectomy. An otolaryngologist typically performs the intervention in a hospital or other facility when the bleeding requires procedural control. The documented source should be nasopharyngeal; bleeding confined to the oropharynx is coded from a different family.

Report 42970 when packing is the method used to control the nasopharyngeal hemorrhage. The record should identify the bleeding site, whether the episode is primary or recurrent, the packing intervention, and the clinical circumstances. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care 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. Medicare does not pay an assistant at surgery for this code; 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 42970 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

42970 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$333.96
Alaska*Unavailable$456.22
ArizonaUnavailable$355.85
ArkansasUnavailable$330.19
AtlantaUnavailable$372.90
AustinUnavailable$370.17
BakersfieldUnavailable$371.30
Baltimore/Surr. CntysUnavailable$384.76
BeaumontUnavailable$349.18
BrazoriaUnavailable$358.49

42970 rates by state

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

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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
42970 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 42970 rate is calculated

Each of 42970’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 · 42970

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.67Practice expense 4.41Malpractice 0.83

10.9100 adjusted RVUs×$33.4009 conversion factor=$364.40

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

Payment rules and modifiers for 42970

42970 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42970

Bleeding control

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)1Not paid (statutory restriction).
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 · 42970

Bleeding control

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

42970 without 51 · national facility

$364.40

Bleeding control

42970-51 · Second procedure: 50%

$182.20

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

42970 compared with similar codes

Compare codes

42970 vs 42960 vs 42971 vs 30905: national Medicare rates

Swap in your local Medicare rate.

  • 42970
    Bleeding control · 5.67 wRVU
    —
  • 42960
    Throat bleeding control · 2.32 wRVU
    —
  • 42971
    Bleeding control · 6.44 wRVU
    —
  • 30905
    Nosebleed control · 1.92 wRVU
    $395.47

How to choose

42960Throat bleeding control
This code family addresses bleeding in the oropharynx, such as a tonsillar-bed source. Use 42970 for nasopharyngeal bleeding controlled with packing.
42971Bleeding control
Both codes address nasopharyngeal hemorrhage, but the selected code depends on the control method documented. 42970 is the packing-based service.
30905Nosebleed control
This code is for initial control of posterior epistaxis. Use 42970 when the service is control of nasopharyngeal hemorrhage with packing, rather than a posterior-epistaxis service.

Codes related to 42970

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

Codes related to 42970
CodeHow it relatesNational office range
Same family
42971Bleeding controlSibling code for nasopharyngeal hemorrhage control using a different specified intervention.No office rate
42972Nasal bleeding controlSibling code for nasopharyngeal hemorrhage control using a different specified intervention.No office rate
Used instead
42960Throat bleeding controlFor control of oropharyngeal rather than nasopharyngeal hemorrhage.No office rate
42961Hemorrhage controlOropharyngeal hemorrhage control when the documented situation meets that code's criteria.No office rate
42962Throat bleeding controlOropharyngeal hemorrhage control when the documented situation meets that code's criteria.No office rate

42970 billing questions

How does 42970 differ from codes 42971 and 42972?

These are sibling codes for control of nasopharyngeal hemorrhage, distinguished by the intervention used. Report 42970 when packing is used; select the sibling matching the documented method for other approaches.

Can 42970 be used for bleeding after tonsillectomy?

Use this code for a nasopharyngeal source controlled with packing. Hemorrhage arising in the oropharynx, such as a tonsillar-bed bleed, belongs to the 42960–42962 code family.

Is packing separately reported with 42970?

Packing is the defining intervention for this service. Do not report it again as a separate service for the same hemorrhage-control work.

Does modifier 50 apply when both sides are packed?

No. CMS indicates that bilateral adjustment does not apply and modifier 50 is inappropriate for this code.

What postoperative services are included in the global period?

The 90-day global period includes the day-before preoperative visit and related postoperative care. CMS also applies the standard multiple-procedure reduction when other procedures are performed in the same session.

Can an assistant or co-surgeon be reported?

Medicare does not pay an assistant at surgery for 42970, and co-surgeons and team surgery are not permitted.

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 42970PPRRVU2026_Oct_nonQPP.csv, line 5,104 (RVU26D)

Open CMS sourceHow we calculate rates

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