No office rate
42960 describes simple control of primary or recurrent oropharyngeal bleeding. This code represents control involving secondary surgical intervention.
On this page
CMS RVU26D · Effective 2026-10-01
42962 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$453.38
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Otolaryngology surgery
About 42962: Oropharyngeal hemorrhage control with secondary surgery
Reports surgical control of primary or recurrent oropharyngeal bleeding when treatment involves a secondary surgical intervention, such as for post-tonsillectomy hemorrhage.
This service controls bleeding in the oropharynx through a secondary surgical intervention. A typical situation is a patient returning for operative treatment of bleeding after tonsillectomy. An otolaryngologist or another surgeon qualified to treat the bleeding source may perform the service in a hospital or other surgical setting. The operative work addresses active or recurrent hemorrhage, rather than simply repairing a throat wound or treating bleeding from a different anatomic site.
Select this level when the record supports secondary surgical intervention; distinguish it from simple control and the neighboring complicated level based on the documented service. The operative report should identify the bleeding site, its primary or recurrent nature, and the intervention used to achieve hemostasis. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 42962
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.22 · 53%
- Practice expense (office) RVU5.43 · 40%
- Malpractice RVU1.06 · 8%
147
Medicare services in 2024 · #4577 by national volume
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.
42962 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
42961 is the complicated level requiring hospitalization. This code is distinguished by secondary surgical intervention, as documented in the operative report.
No office rate
Use the 42970 family when the bleeding site and procedure fit its pharynx or nasopharynx hemorrhage-control levels; this code is for oropharyngeal bleeding requiring secondary surgical intervention.
No office rate
42900 repairs a throat wound. Report this code when the service is surgical control of primary or recurrent oropharyngeal hemorrhage, not wound repair.
The same code, a different location
How does Delaware compare?
42962 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 42962
Office
Unavailable
Facility
$419.89
No comparable office rate is available.
Arkansas
Arkansas · 42962
Office
Unavailable
Facility
$415.18
No comparable office rate is available.
Arizona
Arizona · 42962
Office
Unavailable
Facility
$447.21
No comparable office rate is available.
Bakersfield
California · 42962
Office
Unavailable
Facility
$466.08
No comparable office rate is available.
Chico
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
El Centro
California · 42962
Office
Unavailable
Facility
$463.19
No comparable office rate is available.
Fresno
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Hanford-Corcoran
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Madera
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Merced
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Modesto
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Napa
California · 42962
Office
Unavailable
Facility
$513.37
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42962
Office
Unavailable
Facility
$484.34
No comparable office rate is available.
Redding
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Rest Of California
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42962
Office
Unavailable
Facility
$474.47
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42962
Office
Unavailable
Facility
$479.74
No comparable office rate is available.
Salinas
California · 42962
Office
Unavailable
Facility
$477.81
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42962
Office
Unavailable
Facility
$484.49
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42962
Office
Unavailable
Facility
$536.04
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42962
Office
Unavailable
Facility
$534.84
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42962
Office
Unavailable
Facility
$548.19
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42962
Office
Unavailable
Facility
$543.27
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42962
Office
Unavailable
Facility
$470.81
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42962
Office
Unavailable
Facility
$485.56
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42962
Office
Unavailable
Facility
$478.36
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42962
Office
Unavailable
Facility
$490.08
No comparable office rate is available.
Stockton
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Vallejo
California · 42962
Office
Unavailable
Facility
$511.64
No comparable office rate is available.
Visalia
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Yuba City
California · 42962
Office
Unavailable
Facility
$463.01
No comparable office rate is available.
Colorado
Colorado · 42962
Office
Unavailable
Facility
$464.67
No comparable office rate is available.
Connecticut
Connecticut · 42962
Office
Unavailable
Facility
$484.15
No comparable office rate is available.
Fort Lauderdale
Florida · 42962
Office
Unavailable
Facility
$488.89
No comparable office rate is available.
Rest Of Florida
Florida · 42962
Office
Unavailable
Facility
$467.75
No comparable office rate is available.
Atlanta
Georgia · 42962
Office
Unavailable
Facility
$468.67
No comparable office rate is available.
Rest Of Georgia
Georgia · 42962
Office
Unavailable
Facility
$445.14
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42962
Office
Unavailable
Facility
$467.87
No comparable office rate is available.
Iowa
Iowa · 42962
Office
Unavailable
Facility
$421.16
No comparable office rate is available.
Idaho
Idaho · 42962
Office
Unavailable
Facility
$424.76
No comparable office rate is available.
East St. Louis
Illinois · 42962
Office
Unavailable
Facility
$479.32
No comparable office rate is available.
Rest Of Illinois
Illinois · 42962
Office
Unavailable
Facility
$462.08
No comparable office rate is available.
Suburban Chicago
Illinois · 42962
Office
Unavailable
Facility
$491.84
No comparable office rate is available.
Indiana
Indiana · 42962
Office
Unavailable
Facility
$426.49
No comparable office rate is available.
Kansas
Kansas · 42962
Office
Unavailable
Facility
$422.95
No comparable office rate is available.
Kentucky
Kentucky · 42962
Office
Unavailable
Facility
$434.79
No comparable office rate is available.
New Orleans
Louisiana · 42962
Office
Unavailable
Facility
$452.04
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42962
Office
Unavailable
Facility
$435.58
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42962
Office
Unavailable
Facility
$499.10
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42962
Office
Unavailable
Facility
$464.21
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42962
Office
Unavailable
Facility
$483.42
No comparable office rate is available.
Rest Of Maryland
Maryland · 42962
Office
Unavailable
Facility
$459.61
No comparable office rate is available.
Rest Of Maine
Maine · 42962
Office
Unavailable
Facility
$430.03
No comparable office rate is available.
Southern Maine
Maine · 42962
Office
Unavailable
Facility
$443.23
No comparable office rate is available.
Detroit
Michigan · 42962
Office
Unavailable
Facility
$475.87
No comparable office rate is available.
Rest Of Michigan
Michigan · 42962
Office
Unavailable
Facility
$446.71
No comparable office rate is available.
Minnesota
Minnesota · 42962
Office
Unavailable
Facility
$438.26
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42962
Office
Unavailable
Facility
$446.05
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42962
Office
Unavailable
Facility
$449.29
No comparable office rate is available.
Rest Of Missouri
Missouri · 42962
Office
Unavailable
Facility
$431.98
No comparable office rate is available.
Mississippi
Mississippi · 42962
Office
Unavailable
Facility
$423.48
No comparable office rate is available.
Montana**
Montana · 42962
Office
Unavailable
Facility
$457.86
No comparable office rate is available.
North Carolina
North Carolina · 42962
Office
Unavailable
Facility
$432.99
No comparable office rate is available.
North Dakota**
North Dakota · 42962
Office
Unavailable
Facility
$436.90
No comparable office rate is available.
Nebraska
Nebraska · 42962
Office
Unavailable
Facility
$421.94
No comparable office rate is available.
New Hampshire
New Hampshire · 42962
Office
Unavailable
Facility
$460.94
No comparable office rate is available.
Northern Nj
New Jersey · 42962
Office
Unavailable
Facility
$504.55
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42962
Office
Unavailable
Facility
$487.69
No comparable office rate is available.
New Mexico
New Mexico · 42962
Office
Unavailable
Facility
$449.99
No comparable office rate is available.
Nevada**
Nevada · 42962
Office
Unavailable
Facility
$452.20
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42962
Office
Unavailable
Facility
$537.98
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42962
Office
Unavailable
Facility
$493.44
No comparable office rate is available.
Queens
New York · 42962
Office
Unavailable
Facility
$522.02
No comparable office rate is available.
Rest Of New York
New York · 42962
Office
Unavailable
Facility
$438.34
No comparable office rate is available.
Ohio
Ohio · 42962
Office
Unavailable
Facility
$442.43
No comparable office rate is available.
Oklahoma
Oklahoma · 42962
Office
Unavailable
Facility
$430.62
No comparable office rate is available.
Portland
Oregon · 42962
Office
Unavailable
Facility
$472.85
No comparable office rate is available.
Rest Of Oregon
Oregon · 42962
Office
Unavailable
Facility
$446.69
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42962
Office
Unavailable
Facility
$476.54
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42962
Office
Unavailable
Facility
$441.11
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42962
Office
Unavailable
Facility
$459.39
No comparable office rate is available.
Rhode Island
Rhode Island · 42962
Office
Unavailable
Facility
$464.67
No comparable office rate is available.
South Carolina
South Carolina · 42962
Office
Unavailable
Facility
$438.83
No comparable office rate is available.
South Dakota**
South Dakota · 42962
Office
Unavailable
Facility
$434.42
No comparable office rate is available.
Tennessee
Tennessee · 42962
Office
Unavailable
Facility
$425.03
No comparable office rate is available.
Austin
Texas · 42962
Office
Unavailable
Facility
$464.89
No comparable office rate is available.
Beaumont
Texas · 42962
Office
Unavailable
Facility
$439.09
No comparable office rate is available.
Brazoria
Texas · 42962
Office
Unavailable
Facility
$450.43
No comparable office rate is available.
Dallas
Texas · 42962
Office
Unavailable
Facility
$454.34
No comparable office rate is available.
Fort Worth
Texas · 42962
Office
Unavailable
Facility
$452.99
No comparable office rate is available.
Galveston
Texas · 42962
Office
Unavailable
Facility
$452.50
No comparable office rate is available.
Houston
Texas · 42962
Office
Unavailable
Facility
$471.90
No comparable office rate is available.
Rest Of Texas
Texas · 42962
Office
Unavailable
Facility
$445.24
No comparable office rate is available.
Utah
Utah · 42962
Office
Unavailable
Facility
$443.43
No comparable office rate is available.
Virginia
Virginia · 42962
Office
Unavailable
Facility
$444.43
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42962
Office
Unavailable
Facility
$459.39
No comparable office rate is available.
Vermont
Vermont · 42962
Office
Unavailable
Facility
$438.62
No comparable office rate is available.
Rest Of Washington
Washington · 42962
Office
Unavailable
Facility
$462.21
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42962
Office
Unavailable
Facility
$504.68
No comparable office rate is available.
Wisconsin
Wisconsin · 42962
Office
Unavailable
Facility
$425.81
No comparable office rate is available.
West Virginia
West Virginia · 42962
Office
Unavailable
Facility
$449.43
No comparable office rate is available.
Wyoming**
Wyoming · 42962
Office
Unavailable
Facility
$448.72
No comparable office rate is available.
See how rates vary across the country
42962 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 42962 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$498.72
$453.38 × 110% = $498.72
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42962 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
5,103
- Code
- 42962
- Physician work
- 7.22
- Practice expense
- 5.43
- Malpractice
- 1.06
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.22 | × 1.005 | 7.2561 |
| Practice expense | 5.43 | × 0.988 | 5.3648 |
| Malpractice | 1.06 | × 0.899 | 0.9529 |
| Total RVUs | 13.5739 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$453.38
Open 42962 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.22 | 1.005 |
| Practice expense | 5.43 | 0.988 |
| Malpractice | 1.06 | 0.899 |
(7.22 × 1.005 + 5.43 × 0.988 + 1.06 × 0.899) × $33.4009 = $453.38
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
42962 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $453.38 | RVU26D |
| 2026-07-01 | Not available in this setting | $453.38 | RVU26C |
| 2026-04-01 | Not available in this setting | $453.38 | RVU26B |
| 2026-01-01 | Not available in this setting | $453.38 | RVU26A |
| 2025-10-01 | Not available in this setting | $506.08 | RVU25D |
| 2025-07-01 | Not available in this setting | $506.08 | RVU25C |
| 2025-04-01 | Not available in this setting | $506.08 | RVU25B |
| 2025-01-01 | Not available in this setting | $506.08 | RVU25A |
42962 billing questions
How is this code distinguished from 42960 and 42961?
This level is for control involving secondary surgical intervention. Choose between the neighboring levels based on whether the documented service is simple control, complicated control requiring hospitalization, or secondary surgical intervention.
What documentation supports reporting this service?
The operative report should identify the oropharyngeal bleeding site, whether the bleeding is primary or recurrent, and the secondary surgical intervention performed to control it.
Are related postoperative visits included?
Yes. Medicare assigns a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
How does Medicare handle this service when other procedures occur in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple procedure reduction, with payment at 50%.
Should modifier 50 be used for bleeding on both sides?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,10042955,,Surgical opening of throat,A,,7.81,11.91,NA,11.91,,1.14,20.86,20.86,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10142960,,Control throat bleeding,A,,2.32,1.67,NA,1.67,,0.37,4.36,4.36,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10242961,,Control throat bleeding,A,,5.63,4.71,NA,4.71,,0.82,11.16,11.16,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10342962,,Control throat bleeding,A,,7.22,5.43,NA,5.43,,1.06,13.71,13.71,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10442970,,Control nose/throat bleeding,A,,5.67,4.41,NA,4.41,,0.83,10.91,10.91,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10542971,,Control nose/throat bleeding,A,,6.44,4.60,NA,4.60,,0.93,11.97,11.97,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10642972,,Control nose/throat bleeding,A,,7.40,4.83,NA,4.83,,1.08,13.31,13.31,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503