No office rate
42900 is for repair of a throat wound. Use 42950 when the operative work reconstructs or reshapes pharyngeal tissue.
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CMS RVU26D · Effective 2026-10-01
42950 Pharyngoplasty Medicare reimbursement rates in Guam
Pharyngoplasty reconstructs or reshapes pharyngeal tissues, including in selected patients with velopharyngeal insufficiency or a pharyngeal defect. Compare 42950 office and facility rates across CMS payment localities in Guam.
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 42950 in Guam?
Guam 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
$774.34
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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 42950: Pharyngeal reconstructive surgery
Pharyngoplasty reconstructs or reshapes pharyngeal tissues, including in selected patients with velopharyngeal insufficiency or a pharyngeal defect.
An otolaryngologist or reconstructive surgeon performs pharyngoplasty to reshape or restore tissue in the pharynx. A common clinical setting is treatment of velopharyngeal insufficiency, when inadequate closure between the throat and nasal passage affects speech; the operation may also address a pharyngeal defect requiring reconstruction. The specific technique depends on the anatomy and the reconstructive goal, and the service is typically performed in an operating room.
Report this code for reconstructive work on the pharynx, not a simple repair of a throat wound or an operation directed at the esophagus. The operative report should identify the pharyngeal anatomy treated, the reconstructive work performed, and the indication. This is major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 42950
- 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 paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU8.06 · 37%
- Practice expense (office) RVU12.69 · 58%
- Malpractice RVU1.20 · 5%
735
Medicare services in 2024 · #3218 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.
42950 compared with similar codes
Office rates for Guam, from the same CMS release.
No office rate
42225 identifies secondary cleft palate surgery with a pharyngeal flap. Code 42950 is for pharyngeal reconstruction not captured by that specific cleft-palate service.
No office rate
42953 concerns repair involving the throat and esophagus. Code 42950 is directed at reconstruction of the pharynx.
42999
No office rateUnlisted px phrnx adnd/tnsl
Use 42950 when the documented pharyngeal reconstruction matches this specific service; 42999 is for an applicable procedure without a specific listed code.
Compare 42950 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$774.34
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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 42950 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
5,098
- Code
- 42950
- Physician work
- 8.06
- Practice expense
- 12.69
- Malpractice
- 1.20
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.06 | × 1.000 | 8.0600 |
| Practice expense | 12.69 | × 1.137 | 14.4285 |
| Malpractice | 1.20 | × 0.579 | 0.6948 |
| Total RVUs | 23.1833 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$774.34
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.06 | 1 |
| Practice expense | 12.69 | 1.137 |
| Malpractice | 1.2 | 0.579 |
(8.06 × 1 + 12.69 × 1.137 + 1.2 × 0.579) × $33.4009 = $774.34
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.
42950 billing questions
When should I report pharyngoplasty rather than throat wound repair?
Report pharyngoplasty for reconstructive reshaping or restoration of pharyngeal tissue. Code 42900 is for repair of a throat wound, such as an injury requiring wound closure.
Is a secondary cleft palate repair with a pharyngeal flap the same service?
No. Code 42225 describes a specific secondary cleft palate operation with a pharyngeal flap; choose based on the operation actually performed and documented.
Can modifier 50 be used for a bilateral pharyngoplasty?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does payment change when other procedures are performed in the same session?
Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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.
5,09542900,,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
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
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014