No office rate
Both include tympanoplasty and mastoidectomy, but 69642 includes ossicular chain reconstruction; 69641 does not.
On this page
CMS RVU26D · Effective 2026-10-01
69642 Tympanoplasty Medicare reimbursement rates in Georgia
Reports tympanic membrane repair with mastoid surgery and ossicular chain reconstruction for selected chronic middle-ear disease and conductive hearing loss. Compare 69642 office and facility rates across CMS payment localities in Georgia.
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 69642 in Georgia?
Georgia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1141.12–$1211.48
2 of 2 localities have a supported rate.
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 69642: Tympanoplasty with mastoidectomy and ossicular reconstruction
Reports tympanic membrane repair with mastoid surgery and ossicular chain reconstruction for selected chronic middle-ear disease and conductive hearing loss.
An otolaryngologist performs this operation when disease or damage involves the tympanic membrane, middle ear, and mastoid, and the ossicular chain also requires reconstruction. The combined procedure includes mastoid work and tympanic membrane repair, with middle-ear surgery and canalplasty as needed. Typical cases involve chronic middle-ear disease or cholesteatoma with ossicular disruption; the operation is generally performed in a hospital or ambulatory surgery center.
Report 69642 when the operative service includes mastoidectomy and ossicular chain reconstruction. Distinguish it from tympanoplasty without mastoidectomy and from mastoid procedures without chain reconstruction; document the middle-ear and mastoid findings, the work performed, and the reconstruction. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; co-surgeons and team surgery are not permitted.
CMS billing rules for 69642
- 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 procedure with modifier 50 is paid at 150%.
- 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 RVU16.63 · 47%
- Practice expense (office) RVU16.41 · 46%
- Malpractice RVU2.43 · 7%
158
Medicare services in 2024 · #4526 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.
69642 compared with similar codes
Office rates for Georgia, from the same CMS release.
No office rate
Compare the reconstruction details and prosthesis used. The neighboring code identifies the synthetic-prosthesis variant.
No office rate
This code is for the radical or complete mastoidectomy variant, rather than the mastoidectomy extent represented by 69642.
No office rate
69636 includes tympanoplasty with ossicular reconstruction but not mastoidectomy. Choose 69642 when mastoidectomy is part of the operation.
Compare 69642 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.
2 of 2 payment localities
Atlanta →
Office / nonfacility
Unavailable
Facility
$1211.48
Rest Of Georgia →
Office / nonfacility
Unavailable
Facility
$1141.12
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.
69642 billing questions
When should 69642 be selected instead of 69641?
Use 69642 when the tympanoplasty and mastoidectomy include ossicular chain reconstruction. Code 69641 is the related option without chain reconstruction.
How does a synthetic prosthesis affect code selection?
Compare 69642 with 69643 when the reconstruction uses a synthetic prosthesis; the operative report should identify the reconstruction performed and materials used.
Can tympanoplasty without mastoidectomy be reported instead?
No, not when mastoidectomy is part of the service. Codes such as 69636 describe tympanoplasty without mastoidectomy and represent a different operative extent.
What documentation supports reporting 69642?
Document the mastoid and middle-ear disease, tympanic membrane repair, and the ossicular chain reconstruction. The operative report should make clear that all parts of the combined service were performed.
How are bilateral procedures and other same-session surgeries handled?
Modifier 50 applies to bilateral surgery, with payment at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%.
Is an assistant or co-surgeon payable for this operation?
Assistant-at-surgery payment is restricted for 69642. Co-surgeons and team surgery are not permitted.
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.
7,62969636,,Rebuild eardrum structures,A,,15.04,21.37,NA,21.37,,2.19,38.60,38.60,0,090,0.07,0.79,0.14,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63069637,,Rebuild eardrum structures,A,,14.94,21.34,NA,21.34,,2.18,38.46,38.46,0,090,0.07,0.79,0.14,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63169641,,Revise middle ear & mastoid,A,,12.57,13.37,NA,13.37,,1.85,27.79,27.79,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63269642,,Revise middle ear & mastoid,A,,16.63,16.41,NA,16.41,,2.43,35.47,35.47,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63369643,,Revise middle ear & mastoid,A,,15.20,15.09,NA,15.09,,2.27,32.56,32.56,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63469644,,Revise middle ear & mastoid,A,,16.80,21.80,NA,21.80,,2.46,41.06,41.06,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,63569645,,Revise middle ear & mastoid,A,,16.29,21.73,NA,21.73,,2.42,40.44,40.44,0,090,0.07,0.79,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00