No office rate
42900 is for suture closure of a pharyngeal wound. 42950 is used for a reconstructive operation on the pharynx.
On this page
CMS RVU26D · Effective 2026-10-01
42900 Pharyngeal repair Medicare reimbursement rates in Connecticut
Reports surgical closure of a wound in the pharynx, such as a traumatic or procedural laceration requiring suture repair. Compare 42900 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 42900 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$304.72
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Otolaryngology surgery
About 42900: Suture repair of pharyngeal wound
Reports surgical closure of a wound in the pharynx, such as a traumatic or procedural laceration requiring suture repair.
This service closes a wound in the pharynx with sutures. It is typically performed by an otolaryngologist or another surgeon when a traumatic injury or an operative injury has left pharyngeal tissue requiring repair. The work may take place in a hospital operating room or another setting appropriate to the patient and injury. The record should identify the wound’s location and cause and describe the repair performed.
Report 42900 for wound closure, rather than a reconstructive operation or a procedure whose purpose is control of pharyngeal bleeding. The 10-day global period includes related postoperative visits 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 for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42900
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.16 · 60%
- Practice expense (office) RVU2.73 · 32%
- Malpractice RVU0.76 · 9%
51
Medicare services in 2024 · #5345 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.
42900 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
Choose 42953 when the repair involves the pharynx and esophagus; 42900 describes closure of a pharyngeal wound.
No office rate
42960 addresses control of pharyngeal or nasopharyngeal bleeding. Use 42900 when the service is suturing a pharyngeal wound.
42999
No office rateUnlisted px phrnx adnd/tnsl
Use 42900 when its wound-closure service fits. 42999 is for a pharyngeal procedure without a more specific listed code.
Compare 42900 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
Unavailable
Facility
$304.72
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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 42900 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,095
- Code
- 42900
- Physician work
- 5.16
- Practice expense
- 2.73
- Malpractice
- 0.76
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.16 | × 1.020 | 5.2632 |
| Practice expense | 2.73 | × 1.077 | 2.9402 |
| Malpractice | 0.76 | × 1.210 | 0.9196 |
| Total RVUs | 9.1230 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$304.72
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.16 | 1.02 |
| Practice expense | 2.73 | 1.077 |
| Malpractice | 0.76 | 1.21 |
(5.16 × 1.02 + 2.73 × 1.077 + 0.76 × 1.21) × $33.4009 = $304.72
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.
42900 billing questions
When should 42900 be chosen over 42950?
Use 42900 for sutured closure of a pharyngeal wound. Code 42950 describes a reconstructive operation on the pharynx, not routine wound closure.
Does 42900 include related postoperative visits?
Yes. Its 10-day global period includes related postoperative visits during the 10 days after the procedure.
How does the multiple-procedure rule affect 42900?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 42900?
Document the pharyngeal wound’s location and cause, and describe the suture repair performed. The record should make clear that the service was wound closure rather than reconstruction or bleeding control.
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.
5,09242890,,Limited pharyngectomy,A,,18.65,16.17,NA,16.17,,2.76,37.58,37.58,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09342892,,Revision of pharyngeal walls,A,,25.38,20.06,NA,20.06,,3.70,49.14,49.14,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09442894,,Revision of pharyngeal walls,A,,33.07,24.14,NA,24.14,,4.84,62.05,62.05,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09542900,,Repair throat wound,A,,5.16,2.73,NA,2.73,,0.76,8.65,8.65,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0964290F,,Pt scrned for inj drug use,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,0974293F,,Pt scrnd hgh-risk sex behav,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09842950,,Reconstruction of throat,A,,8.06,12.69,NA,12.69,,1.20,21.95,21.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
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