No office rate
42960 covers simple control of oropharyngeal hemorrhage. Choose 42961 when the complicated episode requires hospitalization.
On this page
CMS RVU26D · Effective 2026-10-01
42961 in Wyoming**
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$365.63
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 42961: Complicated oropharyngeal hemorrhage control
Reports operative control of complicated oropharyngeal bleeding that requires hospitalization, such as significant post-tonsillectomy hemorrhage requiring surgical hemostasis.
An otolaryngologist typically reports this service when controlling complicated bleeding from the oropharynx, including significant hemorrhage after tonsillectomy that requires hospitalization. The procedure may involve operative hemostasis, such as cauterizing or ligating the bleeding source. The code level is based on the documented complexity and hospitalization requirement, not simply on the presence of bleeding.
Choose 42961 when the complicated hemorrhage requires hospitalization; 42962 is the sibling code when hospitalization and general anesthesia are required. The record should identify the bleeding site, clinical circumstances, treatment performed, and reason hospitalization was required. This major surgery code includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are reduced to 50%. Bilateral adjustment is not appropriate. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42961
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.63 · 50%
- Practice expense (office) RVU4.71 · 42%
- Malpractice RVU0.82 · 7%
59
Medicare services in 2024 · #5256 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.
42961 compared with similar codes
Office rates for Wyoming**, from the same CMS release.
No office rate
42962 applies when complicated hemorrhage requires hospitalization and general anesthesia; 42961 is for the hospitalization-level service without that added criterion.
No office rate
42970 is in the nose/throat hemorrhage-control group. Select based on the applicable bleeding site and procedure rather than treating it as the oropharyngeal hemorrhage code.
The same code, a different location
How does Wyoming** compare?
42961 across payment areas
Same release and payment basis · bars start at $0
Wyoming** · 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 Wyoming 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 · 42961
Office
Unavailable
Facility
$341.20
No comparable office rate is available.
Arkansas
Arkansas · 42961
Office
Unavailable
Facility
$337.29
No comparable office rate is available.
Arizona
Arizona · 42961
Office
Unavailable
Facility
$363.93
No comparable office rate is available.
Bakersfield
California · 42961
Office
Unavailable
Facility
$380.72
No comparable office rate is available.
Chico
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
El Centro
California · 42961
Office
Unavailable
Facility
$378.48
No comparable office rate is available.
Fresno
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Hanford-Corcoran
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Madera
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Merced
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Modesto
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Napa
California · 42961
Office
Unavailable
Facility
$421.15
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42961
Office
Unavailable
Facility
$396.33
No comparable office rate is available.
Redding
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Rest Of California
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42961
Office
Unavailable
Facility
$387.22
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42961
Office
Unavailable
Facility
$392.46
No comparable office rate is available.
Salinas
California · 42961
Office
Unavailable
Facility
$390.89
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42961
Office
Unavailable
Facility
$396.69
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42961
Office
Unavailable
Facility
$440.30
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42961
Office
Unavailable
Facility
$439.37
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42961
Office
Unavailable
Facility
$450.27
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42961
Office
Unavailable
Facility
$446.46
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42961
Office
Unavailable
Facility
$385.11
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42961
Office
Unavailable
Facility
$397.82
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42961
Office
Unavailable
Facility
$391.43
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42961
Office
Unavailable
Facility
$401.56
No comparable office rate is available.
Stockton
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Vallejo
California · 42961
Office
Unavailable
Facility
$419.81
No comparable office rate is available.
Visalia
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Yuba City
California · 42961
Office
Unavailable
Facility
$378.35
No comparable office rate is available.
Colorado
Colorado · 42961
Office
Unavailable
Facility
$379.08
No comparable office rate is available.
Connecticut
Connecticut · 42961
Office
Unavailable
Facility
$394.38
No comparable office rate is available.
Delaware
Delaware · 42961
Office
Unavailable
Facility
$369.04
No comparable office rate is available.
Fort Lauderdale
Florida · 42961
Office
Unavailable
Facility
$396.93
No comparable office rate is available.
Rest Of Florida
Florida · 42961
Office
Unavailable
Facility
$379.61
No comparable office rate is available.
Atlanta
Georgia · 42961
Office
Unavailable
Facility
$381.34
No comparable office rate is available.
Rest Of Georgia
Georgia · 42961
Office
Unavailable
Facility
$361.02
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42961
Office
Unavailable
Facility
$382.78
No comparable office rate is available.
Iowa
Iowa · 42961
Office
Unavailable
Facility
$342.87
No comparable office rate is available.
Idaho
Idaho · 42961
Office
Unavailable
Facility
$345.73
No comparable office rate is available.
East St. Louis
Illinois · 42961
Office
Unavailable
Facility
$387.94
No comparable office rate is available.
Rest Of Illinois
Illinois · 42961
Office
Unavailable
Facility
$374.49
No comparable office rate is available.
Suburban Chicago
Illinois · 42961
Office
Unavailable
Facility
$399.46
No comparable office rate is available.
Indiana
Indiana · 42961
Office
Unavailable
Facility
$347.19
No comparable office rate is available.
Kansas
Kansas · 42961
Office
Unavailable
Facility
$344.07
No comparable office rate is available.
Kentucky
Kentucky · 42961
Office
Unavailable
Facility
$352.96
No comparable office rate is available.
New Orleans
Louisiana · 42961
Office
Unavailable
Facility
$367.20
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42961
Office
Unavailable
Facility
$353.51
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42961
Office
Unavailable
Facility
$407.97
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42961
Office
Unavailable
Facility
$378.54
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42961
Office
Unavailable
Facility
$393.74
No comparable office rate is available.
Rest Of Maryland
Maryland · 42961
Office
Unavailable
Facility
$374.28
No comparable office rate is available.
Rest Of Maine
Maine · 42961
Office
Unavailable
Facility
$349.82
No comparable office rate is available.
Southern Maine
Maine · 42961
Office
Unavailable
Facility
$361.23
No comparable office rate is available.
Detroit
Michigan · 42961
Office
Unavailable
Facility
$386.04
No comparable office rate is available.
Rest Of Michigan
Michigan · 42961
Office
Unavailable
Facility
$362.60
No comparable office rate is available.
Minnesota
Minnesota · 42961
Office
Unavailable
Facility
$358.03
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42961
Office
Unavailable
Facility
$362.53
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42961
Office
Unavailable
Facility
$365.26
No comparable office rate is available.
Rest Of Missouri
Missouri · 42961
Office
Unavailable
Facility
$350.33
No comparable office rate is available.
Mississippi
Mississippi · 42961
Office
Unavailable
Facility
$343.74
No comparable office rate is available.
Montana**
Montana · 42961
Office
Unavailable
Facility
$372.70
No comparable office rate is available.
North Carolina
North Carolina · 42961
Office
Unavailable
Facility
$352.33
No comparable office rate is available.
North Dakota**
North Dakota · 42961
Office
Unavailable
Facility
$356.49
No comparable office rate is available.
Nebraska
Nebraska · 42961
Office
Unavailable
Facility
$343.60
No comparable office rate is available.
New Hampshire
New Hampshire · 42961
Office
Unavailable
Facility
$375.78
No comparable office rate is available.
Northern Nj
New Jersey · 42961
Office
Unavailable
Facility
$411.63
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42961
Office
Unavailable
Facility
$397.41
No comparable office rate is available.
New Mexico
New Mexico · 42961
Office
Unavailable
Facility
$365.20
No comparable office rate is available.
Nevada**
Nevada · 42961
Office
Unavailable
Facility
$368.34
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42961
Office
Unavailable
Facility
$437.99
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42961
Office
Unavailable
Facility
$401.91
No comparable office rate is available.
Queens
New York · 42961
Office
Unavailable
Facility
$425.53
No comparable office rate is available.
Rest Of New York
New York · 42961
Office
Unavailable
Facility
$356.75
No comparable office rate is available.
Ohio
Ohio · 42961
Office
Unavailable
Facility
$359.29
No comparable office rate is available.
Oklahoma
Oklahoma · 42961
Office
Unavailable
Facility
$349.81
No comparable office rate is available.
Portland
Oregon · 42961
Office
Unavailable
Facility
$386.21
No comparable office rate is available.
Rest Of Oregon
Oregon · 42961
Office
Unavailable
Facility
$363.99
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42961
Office
Unavailable
Facility
$387.87
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42961
Office
Unavailable
Facility
$358.35
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42961
Office
Unavailable
Facility
$374.07
No comparable office rate is available.
Rhode Island
Rhode Island · 42961
Office
Unavailable
Facility
$378.56
No comparable office rate is available.
South Carolina
South Carolina · 42961
Office
Unavailable
Facility
$356.69
No comparable office rate is available.
South Dakota**
South Dakota · 42961
Office
Unavailable
Facility
$354.57
No comparable office rate is available.
Tennessee
Tennessee · 42961
Office
Unavailable
Facility
$345.76
No comparable office rate is available.
Austin
Texas · 42961
Office
Unavailable
Facility
$379.13
No comparable office rate is available.
Beaumont
Texas · 42961
Office
Unavailable
Facility
$356.65
No comparable office rate is available.
Brazoria
Texas · 42961
Office
Unavailable
Facility
$366.82
No comparable office rate is available.
Dallas
Texas · 42961
Office
Unavailable
Facility
$369.93
No comparable office rate is available.
Fort Worth
Texas · 42961
Office
Unavailable
Facility
$368.71
No comparable office rate is available.
Galveston
Texas · 42961
Office
Unavailable
Facility
$368.45
No comparable office rate is available.
Houston
Texas · 42961
Office
Unavailable
Facility
$383.46
No comparable office rate is available.
Rest Of Texas
Texas · 42961
Office
Unavailable
Facility
$362.07
No comparable office rate is available.
Utah
Utah · 42961
Office
Unavailable
Facility
$360.52
No comparable office rate is available.
Virginia
Virginia · 42961
Office
Unavailable
Facility
$362.03
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42961
Office
Unavailable
Facility
$374.07
No comparable office rate is available.
Vermont
Vermont · 42961
Office
Unavailable
Facility
$357.65
No comparable office rate is available.
Rest Of Washington
Washington · 42961
Office
Unavailable
Facility
$376.99
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42961
Office
Unavailable
Facility
$412.86
No comparable office rate is available.
Wisconsin
Wisconsin · 42961
Office
Unavailable
Facility
$347.19
No comparable office rate is available.
West Virginia
West Virginia · 42961
Office
Unavailable
Facility
$363.95
No comparable office rate is available.
See how rates vary across the country
42961 · 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?
Wyoming** is a Medicare payment area. Our Census mapping connects it to 205 cities and communities in Wyoming, 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 42961 in Wyoming**. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$402.19
$365.63 × 110% = $402.19
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 42961 in Wyoming**.
PPRRVU2026_Oct_nonQPP.csv
5,102
- Code
- 42961
- Physician work
- 5.63
- Practice expense
- 4.71
- Malpractice
- 0.82
GPCI2026.csv
112
- Locality
- Wyoming**
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.740
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.63 | × 1.000 | 5.6300 |
| Practice expense | 4.71 | × 1.000 | 4.7100 |
| Malpractice | 0.82 | × 0.740 | 0.6068 |
| Total RVUs | 10.9468 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wyoming**$365.63
Open 42961 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.63 | 1 |
| Practice expense | 4.71 | 1 |
| Malpractice | 0.82 | 0.74 |
(5.63 × 1 + 4.71 × 1 + 0.82 × 0.74) × $33.4009 = $365.63
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
42961 · 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 | $365.63 | RVU26D |
| 2026-07-01 | Not available in this setting | $365.63 | RVU26C |
| 2026-04-01 | Not available in this setting | $365.63 | RVU26B |
| 2026-01-01 | Not available in this setting | $365.63 | RVU26A |
| 2025-10-01 | Not available in this setting | $404.76 | RVU25D |
| 2025-07-01 | Not available in this setting | $404.76 | RVU25C |
| 2025-04-01 | Not available in this setting | $404.76 | RVU25B |
| 2025-01-01 | Not available in this setting | $404.76 | RVU25A |
42961 billing questions
How does 42961 differ from 42960?
42961 is for complicated oropharyngeal hemorrhage requiring hospitalization. Use 42960 for simple control of primary or secondary oropharyngeal hemorrhage.
When is 42962 the better choice?
Use 42962 when the complicated hemorrhage requires both hospitalization and general anesthesia. Document the circumstances supporting those requirements.
What documentation supports 42961?
Document the oropharyngeal bleeding site, the control procedure performed, the complexity of the hemorrhage, and why hospitalization was required.
Should modifier 50 be reported for bilateral bleeding?
No. CMS bilateral adjustment does not apply to 42961, and modifier 50 is inappropriate for this code.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.
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.
5,09942953,,Repair throat esophagus,A,,9.21,16.13,NA,16.13,,1.43,26.77,26.77,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10042955,,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
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,
115*Work GPCI reflects a 1.5 floor in Alaska established by the MIPPA.,,,,,,