42950 Pharyngoplasty Medicare reimbursement rates in Michigan

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.