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Billing code 42971: Bleeding controlMedicare rate & RVUs

Reports operative control of complicated bleeding from the pharynx or nasopharynx, such as significant postoperative hemorrhage requiring more than simple treatment.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $399.81 for 42971 nationally in a facility.

Medicare rate · 42971

Bleeding control

Swap in your local Medicare rate.

Work RVUs
6.44
Total RVUs
11.97
Global days
090

National rate · 2026

$399.81

Facility setting, before claim adjustments.

See every locality for 42971 → · 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 42971 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 42971 covers

This code describes operative control of complicated bleeding arising in the pharynx or nasopharynx. An otolaryngologist may perform the service for significant postoperative bleeding, including a difficult tonsillectomy-site hemorrhage, when the work is more involved than simple control. The operative note should identify the bleeding site, its context, the hemostatic work performed, and the circumstances supporting the complicated level.

Choose this level based on the complexity of hemorrhage control, not merely the fact that bleeding occurred. Distinguish it from simple control and from the more extensive level by documenting the actual operative work and clinical circumstances. CMS assigns a 90-day global period, which includes the day-before preoperative visit and 90 days of related postoperative care. 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 multiple procedure reduction. Bilateral adjustment is not appropriate. Assistant-at-surgery payment may be made; 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 42971 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

42971 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$367.12
Alaska*Unavailable$503.40
ArizonaUnavailable$390.57
ArkansasUnavailable$363.08
AtlantaUnavailable$409.16
AustinUnavailable$405.61
BakersfieldUnavailable$406.50
Baltimore/Surr. CntysUnavailable$421.83
BeaumontUnavailable$383.78
BrazoriaUnavailable$393.31

42971 rates by state

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

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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
42971 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 42971 rate is calculated

Each of 42971’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 · 42971

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 6.44Practice expense 4.60Malpractice 0.93

11.9700 adjusted RVUs×$33.4009 conversion factor=$399.81

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

Payment rules and modifiers for 42971

42971 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42971

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)2Paid.
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 · 42971

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

42971 without 51 · national facility

$399.81

Bleeding control

42971-51 · Second procedure: 50%

$199.91

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

42971 compared with similar codes

Compare codes

42971 vs 42970 vs 42972 vs 42961: national Medicare rates

Swap in your local Medicare rate.

  • 42971
    Bleeding control · 6.44 wRVU
    —
  • 42970
    Bleeding control · 5.67 wRVU
    —
  • 42972
    Nasal bleeding control · 7.4 wRVU
    —
  • 42961
    Hemorrhage control · 5.63 wRVU
    —

How to choose

42970Bleeding control
42970 is for simple control of pharyngeal or nasopharyngeal bleeding; 42971 is for the complicated level, supported by the documented circumstances and operative work.
42972Nasal bleeding control
42972 is the more extensive level in this hemorrhage-control series. Select it only when the record supports that greater extent, rather than complicated control alone.
42961Hemorrhage control
42961 belongs to the oropharyngeal hemorrhage series. Use it when the coded site is oropharyngeal, rather than pharyngeal or nasopharyngeal.

Codes related to 42971

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

Codes related to 42971
CodeHow it relatesNational office range
Same family
42970Bleeding controlSimple-level control of pharyngeal or nasopharyngeal hemorrhage.No office rate
42972Nasal bleeding controlMore extensive-level control of pharyngeal or nasopharyngeal hemorrhage.No office rate
Used instead
42960Throat bleeding controlControl code for oropharyngeal hemorrhage when that site and level apply.No office rate
42961Hemorrhage controlComplicated oropharyngeal hemorrhage control; distinguish by the coded bleeding site.No office rate
42962Throat bleeding controlExtensive oropharyngeal hemorrhage control; distinguish by the coded bleeding site.No office rate

42971 billing questions

How does 42971 differ from 42970?

42970 is the simple-control level. Use 42971 when the documented hemorrhage control is complicated; the operative details and circumstances should support that distinction.

When is 42972 more appropriate?

42972 represents the more extensive level of control. The record should support that greater extent of operative work rather than merely describing a difficult or significant bleed.

Can modifier 50 be reported?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used to represent bilateral services.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant-at-surgery be paid?

CMS permits assistant-at-surgery payment for this code. Co-surgeons and team surgery are not permitted.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard multiple procedure reduction.

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 42971PPRRVU2026_Oct_nonQPP.csv, line 5,105 (RVU26D)

Open CMS sourceHow we calculate rates

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