CPT code 42900: Pharyngeal repair2026 Medicare rate & RVUs in Minnesota
Reports surgical closure of a wound in the pharynx, such as a traumatic or procedural laceration requiring suture repair.
CMS doesn’t publish an office rate for 42900 in Minnesota.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 42900 covers
This service closes a wound in the pharynx with sutures. It is typically performed by an otolaryngologist or another surgeon when a traumatic injury or an operative injury has left pharyngeal tissue requiring repair. The work may take place in a hospital operating room or another setting appropriate to the patient and injury. The record should identify the wound’s location and cause and describe the repair performed.
Report 42900 for wound closure, rather than a reconstructive operation or a procedure whose purpose is control of pharyngeal bleeding. The 10-day global period includes related postoperative visits 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
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.
42900 in Minnesota
| Payment locality | Office | Facility |
|---|---|---|
| Minnesota | Unavailable | $273.69 |
How the 42900 rate is calculated
Each of 42900’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 42900
RVUs × geographic indexes × conversion factor
Work5.16
5.16 RVUs× 1.000 GPCI
Practice expense2.73
2.73 RVUs× 1.000 GPCI
Malpractice0.76
0.76 RVUs× 1.000 GPCI
Adjusted RVUs
8.6500
Conversion factor
$33.4009
Medicare rate
$288.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42900
42900 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42900
Pharyngeal repair
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42900
Pharyngeal repair
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42900 without 51 · national facility
$288.92
Pharyngeal repair
42900-51 · Second procedure: 50%
$144.46
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42900 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42950Pharyngoplasty
- 42900 is for suture closure of a pharyngeal wound. 42950 is used for a reconstructive operation on the pharynx.
- 42953Throat repair
- Choose 42953 when the repair involves the pharynx and esophagus; 42900 describes closure of a pharyngeal wound.
- 42960Throat bleeding control
- 42960 addresses control of pharyngeal or nasopharyngeal bleeding. Use 42900 when the service is suturing a pharyngeal wound.
- 42999Unlisted px phrnx adnd/tnsl
- Use 42900 when its wound-closure service fits. 42999 is for a pharyngeal procedure without a more specific listed code.
42900 billing questions
When should 42900 be chosen over 42950?
Use 42900 for sutured closure of a pharyngeal wound. Code 42950 describes a reconstructive operation on the pharynx, not routine wound closure.
Does 42900 include related postoperative visits?
Yes. Its 10-day global period includes related postoperative visits during the 10 days after the procedure.
How does the multiple-procedure rule affect 42900?
When it is performed with other procedures in the same session, the highest-valued procedure is paid in full and the others are subject to a 50% reduction.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
Can an assistant surgeon or co-surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted.
What documentation supports reporting 42900?
Document the pharyngeal wound’s location and cause, and describe the suture repair performed. The record should make clear that the service was wound closure rather than reconstruction or bleeding control.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 42900 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →