No office rate
Use 42970 for initial posterior nasal bleeding control with posterior packing and/or cautery. Use 42972 when endoscopy is used to control the posterior bleed.
On this page
CMS RVU26D · Effective 2026-10-01
42972 Nasal bleeding control Medicare reimbursement rates in Ohio
Report this service when a physician uses endoscopy to control a posterior nasal hemorrhage, such as severe epistaxis requiring operative hemostasis. Compare 42972 office and facility rates across CMS payment localities in Ohio.
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 42972 in Ohio?
Ohio 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
$430.82
1 of 1 localities have a supported rate.
Payment area: Ohio
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 42972: Endoscopic control of posterior nasal bleeding
Report this service when a physician uses endoscopy to control a posterior nasal hemorrhage, such as severe epistaxis requiring operative hemostasis.
This service is endoscopic control of bleeding originating in the posterior nose. An otolaryngologist typically performs it in a hospital or operating room when a posterior nasal hemorrhage needs direct endoscopic visualization and treatment, such as cautery or another hemostatic maneuver. The record should identify the posterior nasal source and describe the endoscopic approach and work used to stop the bleeding.
Choose this code for endoscopic posterior nasal hemorrhage control, rather than the related codes for posterior packing or cautery without endoscopy, or for a subsequent packing-related visit. The 90-day global period includes 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 the others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42972
- 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 RVU7.40 · 56%
- Practice expense (office) RVU4.83 · 36%
- Malpractice RVU1.08 · 8%
12
Medicare services in 2024 · #6149 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.
42972 compared with similar codes
Office rates for Ohio, from the same CMS release.
No office rate
42971 is for subsequent control using posterior packing and/or cautery; 42972 describes endoscopic posterior nasal hemorrhage control.
No office rate
42961 concerns complicated oropharyngeal hemorrhage requiring hospitalization. Choose 42972 for endoscopic control of a posterior nasal bleed.
Compare 42972 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
Ohio →
Office / nonfacility
Unavailable
Facility
$430.82
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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 42972 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
5,106
- Code
- 42972
- Physician work
- 7.40
- Practice expense
- 4.83
- Malpractice
- 1.08
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.40 | × 1.000 | 7.4000 |
| Practice expense | 4.83 | × 0.913 | 4.4098 |
| Malpractice | 1.08 | × 1.008 | 1.0886 |
| Total RVUs | 12.8984 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$430.82
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.4 | 1 |
| Practice expense | 4.83 | 0.913 |
| Malpractice | 1.08 | 1.008 |
(7.4 × 1 + 4.83 × 0.913 + 1.08 × 1.008) × $33.4009 = $430.82
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.
42972 billing questions
How does this differ from 42970?
42972 is for endoscopic control of a posterior nasal bleed. 42970 describes initial control using posterior packing and/or cautery without the endoscopic approach.
When is 42971 used instead?
42971 describes subsequent control of posterior nasal bleeding with packing and/or cautery. Use 42972 when the service is endoscopic control.
Can nasal endoscopy be billed separately?
The endoscopic approach is part of 42972. Document how endoscopy was used to identify and control the posterior nasal bleeding.
Can modifier 50 be reported?
No. The CMS bilateral adjustment does not apply to this service, and modifier 50 is inappropriate.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
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.
5,10342962,,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
5,10442970,,Control nose/throat bleeding,A,,5.67,4.41,NA,4.41,,0.83,10.91,10.91,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10542971,,Control nose/throat bleeding,A,,6.44,4.60,NA,4.60,,0.93,11.97,11.97,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10642972,,Control nose/throat bleeding,A,,7.40,4.83,NA,4.83,,1.08,13.31,13.31,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10742975,,Dise eval slp do brth flx dx,A,,1.54,0.75,NA,0.75,,0.21,2.50,2.50,0,000,0.00,0.00,0.00,3,0,1,0,0,9,31575,33.4009,09,0,99,0.00,0.00,0.00
5,10842999,,Unlisted px phrnx adnd/tnsl,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,33.4009,09,0,99,0.00,0.00,0.00
5,1094300F,,Pt rcvng warf thxpy,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
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703