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 Throat bleeding control Medicare reimbursement rates in Delaware
Reports surgical control of primary or recurrent oropharyngeal bleeding when treatment involves a secondary surgical intervention, such as for post-tonsillectomy hemorrhage. Compare 42962 office and facility rates across CMS payment localities in Delaware.
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 42962 in Delaware?
Delaware 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
$453.38
1 of 1 localities have a supported rate.
Payment area: Delaware
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 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.
Compare 42962 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
Delaware →
Office / nonfacility
Unavailable
Facility
$453.38
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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
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.
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