$116.86
Choose 42975 when flexible endoscopy is performed during medication-induced sleep to assess airway collapse. Code 31575 describes an awake flexible laryngeal examination.
On this page
CMS RVU26D · Effective 2026-10-01
42975 Sleep endoscopy Medicare reimbursement rates in Tennessee
Flexible endoscopy during medication-induced sleep shows patterns of upper-airway collapse in patients being evaluated for obstructive sleep apnea treatment. Compare 42975 office and facility rates across CMS payment localities in Tennessee.
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 42975 in Tennessee?
Tennessee 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
$77.98
1 of 1 localities have a supported rate.
Payment area: Tennessee
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 endoscopy
About 42975: Drug-induced sleep endoscopy
Flexible endoscopy during medication-induced sleep shows patterns of upper-airway collapse in patients being evaluated for obstructive sleep apnea treatment.
An otolaryngologist passes a flexible endoscope through the nose while medication-induced sleep allows assessment of how the upper airway behaves in a sleep-like state. The examination can show collapse involving structures such as the soft palate, pharyngeal walls, tongue base, or epiglottis. It is used in evaluating obstructive sleep apnea, including when airway surgery or hypoglossal nerve stimulation is being considered and the pattern of obstruction may guide treatment planning.
Report 42975 for the medication-induced, flexible endoscopic airway evaluation—not an awake office examination alone. Documentation should support the sleep-like state, the endoscopic findings, and the clinical reason for evaluating airway collapse. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted.
CMS billing rules for 42975
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.54 · 62%
- Practice expense (office) RVU0.75 · 30%
- Malpractice RVU0.21 · 8%
12.6K
Medicare services in 2024 · #1357 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.
42975 compared with similar codes
Office rates for Tennessee, from the same CMS release.
$231.38
Code 31525 is diagnostic direct laryngoscopy. It does not represent flexible endoscopic evaluation of the airway during medication-induced sleep.
$616.58
Polysomnography records sleep and respiratory data to evaluate sleep-disordered breathing; 42975 visualizes the airway during induced sleep to assess collapse patterns.
Compare 42975 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
Tennessee →
Office / nonfacility
Unavailable
Facility
$77.98
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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 42975 in Tennessee.
PPRRVU2026_Oct_nonQPP.csv
5,107
- Code
- 42975
- Physician work
- 1.54
- Practice expense
- 0.75
- Malpractice
- 0.21
GPCI2026.csv
95
- Locality
- Tennessee
- Physician work
- 1.000
- Practice expense
- 0.909
- Malpractice
- 0.537
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.54 | × 1.000 | 1.5400 |
| Practice expense | 0.75 | × 0.909 | 0.6818 |
| Malpractice | 0.21 | × 0.537 | 0.1128 |
| Total RVUs | 2.3345 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Tennessee$77.98
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.54 | 1 |
| Practice expense | 0.75 | 0.909 |
| Malpractice | 0.21 | 0.537 |
(1.54 × 1 + 0.75 × 0.909 + 0.21 × 0.537) × $33.4009 = $77.98
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.
42975 billing questions
How is 42975 different from an awake flexible laryngoscopy?
42975 evaluates airway behavior during medication-induced sleep. An awake flexible laryngoscopy examines the airway while the patient is awake and does not show the same sleep-related collapse pattern.
Can an awake laryngoscopy be separately reported at the same encounter?
Do not report an additional scope service solely for the flexible endoscopic examination inherent in 42975. If another endoscopic service is performed, CMS endoscopy family pricing applies when the procedures are related and performed together.
Should modifier 50 be appended for both sides of the airway?
No. CMS identifies bilateral adjustment as inappropriate for this code; the descriptor or anatomy does not support modifier 50.
Is an assistant surgeon payable?
No. CMS lists a statutory restriction on assistant-at-surgery payment for 42975; co-surgeons and team surgery are also not permitted.
What documentation supports reporting 42975?
Document the clinical reason for assessing sleep-related airway obstruction, the medication-induced sleep-like state, the flexible endoscopic examination, and the observed airway findings.
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.
5,10442970,,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
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5,1104301F,,Pt not 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
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780