No office rate
42900 is for repair of a pharyngeal wound or injury. Choose 42955 for a planned opening to explore the pharynx or remove a foreign body.
On this page
CMS RVU26D · Effective 2026-10-01
42955 Pharyngotomy Medicare reimbursement rates in Maine
Reports a surgical opening into the pharynx to explore the area or remove a foreign body when operative access through the throat is required. Compare 42955 office and facility rates across CMS payment localities in Maine.
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 42955 in Maine?
Maine 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
$650.53–$679.11
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.
Pharyngeal surgery
About 42955: Pharyngotomy for foreign body exploration
Reports a surgical opening into the pharynx to explore the area or remove a foreign body when operative access through the throat is required.
An otolaryngologist or head-and-neck surgeon uses this service to open the pharynx for operative exploration or removal of a foreign body. It is generally performed in an operating room when the target cannot be managed through a less invasive route. The operative note should identify the pharyngeal site, the reason for opening it, the exploration or removal performed, and the method of closure.
Report 42955 for the pharyngotomy itself, not for repair of a traumatic pharyngeal wound or for reconstructive surgery. Routine closure of the surgical opening is part of the service. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care 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% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42955
- 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 RVU7.81 · 37%
- Practice expense (office) RVU11.91 · 57%
- Malpractice RVU1.14 · 5%
17
Medicare services in 2024 · #6008 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.
42955 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
42950 describes pharyngeal reconstruction. It is not the code for opening the pharynx to explore or remove a foreign body.
No office rate
42953 concerns repair involving the pharynx and esophagus. Use 42955 when the operative objective is pharyngeal exploration or foreign-body removal.
No office rate
42960 is for control of oropharyngeal bleeding, not for a pharyngotomy performed to explore the pharynx or remove a foreign body.
Compare 42955 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
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$650.53
Southern Maine →
Office / nonfacility
Unavailable
Facility
$679.11
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42955 billing questions
When is 42955 appropriate instead of a pharyngeal wound repair code?
Use 42955 when the surgeon deliberately opens the pharynx for exploration or foreign-body removal. A traumatic pharyngeal wound repair is a different operative service.
Can the pharyngotomy closure be billed separately?
No. Routine closure of the surgical opening is part of the pharyngotomy service.
Should modifier 50 be appended for bilateral work?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
Can an assistant surgeon be reported?
CMS permits assistant-at-surgery payment for 42955. Co-surgeons and team surgery are not permitted.
What global care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
How does the multiple-procedure reduction affect 42955?
For procedures performed in the same session, CMS pays the highest-valued procedure in full and applies the standard 50% reduction to the others.
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.
5,0974293F,,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
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