Billing code 42950: PharyngoplastyMedicare rate & RVUs in Nebraska
Pharyngoplasty reconstructs or reshapes pharyngeal tissues, including in selected patients with velopharyngeal insufficiency or a pharyngeal defect.
CMS doesn’t publish an office rate for 42950 in Nebraska.
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 42950 covers
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.
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 in Nebraska
| Payment locality | Office | Facility |
|---|---|---|
| Nebraska | Unavailable | $675.58 |
How the 42950 rate is calculated
Each of 42950’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 · 42950
RVUs × geographic indexes × conversion factor
Work8.06
8.06 RVUs× 1.000 GPCI
Practice expense12.69
12.69 RVUs× 1.000 GPCI
Malpractice1.20
1.20 RVUs× 1.000 GPCI
Adjusted RVUs
21.9500
Conversion factor
$33.4009
Medicare rate
$733.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42950
42950 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42950
Pharyngoplasty
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42950
Pharyngoplasty
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42950 without 51 · national facility
$733.15
Pharyngoplasty
42950-51 · Second procedure: 50%
$366.58
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%).
42950 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42900Pharyngeal repair
- 42900 is for repair of a throat wound. Use 42950 when the operative work reconstructs or reshapes pharyngeal tissue.
- 42225Cleft palate repair
- 42225 identifies secondary cleft palate surgery with a pharyngeal flap. Code 42950 is for pharyngeal reconstruction not captured by that specific cleft-palate service.
- 42953Throat repair
- 42953 concerns repair involving the throat and esophagus. Code 42950 is directed at reconstruction of the pharynx.
- 42999Unlisted 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.
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 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
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