Billing code 69642: TympanoplastyMedicare rate & RVUs in Texas
Reports tympanic membrane repair with mastoid surgery and ossicular chain reconstruction for selected chronic middle-ear disease and conductive hearing loss.
CMS doesn’t publish an office rate for 69642 in Texas.
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 69642 covers
An otolaryngologist performs this operation when disease or damage involves the tympanic membrane, middle ear, and mastoid, and the ossicular chain also requires reconstruction. The combined procedure includes mastoid work and tympanic membrane repair, with middle-ear surgery and canalplasty as needed. Typical cases involve chronic middle-ear disease or cholesteatoma with ossicular disruption; the operation is generally performed in a hospital or ambulatory surgery center.
Report 69642 when the operative service includes mastoidectomy and ossicular chain reconstruction. Distinguish it from tympanoplasty without mastoidectomy and from mastoid procedures without chain reconstruction; document the middle-ear and mastoid findings, the work performed, and the reconstruction. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and others at 50%. For bilateral surgery, modifier 50 is paid at 150%. Assistant-at-surgery payment is restricted; 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.
Where 69642 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $1,208.38 |
| Beaumont | Unavailable | $1,129.64 |
| Brazoria | Unavailable | $1,166.38 |
| Dallas | Unavailable | $1,176.01 |
| Fort Worth | Unavailable | $1,171.59 |
| Galveston | Unavailable | $1,171.38 |
| Houston | Unavailable | $1,215.85 |
| Rest Of Texas | Unavailable | $1,148.90 |
How the 69642 rate is calculated
Each of 69642’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 · 69642
RVUs × geographic indexes × conversion factor
Work16.63
16.63 RVUs× 1.000 GPCI
Practice expense16.41
16.41 RVUs× 1.000 GPCI
Malpractice2.43
2.43 RVUs× 1.000 GPCI
Adjusted RVUs
35.4700
Conversion factor
$33.4009
Medicare rate
$1,184.73
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 69642
69642 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69642
Tympanoplasty
| 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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) | 0.07/0.79/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 69642
Tympanoplasty
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 50 · payment effect
With and without the modifier
69642 without 50 · national facility
$1,184.73
Tympanoplasty
69642-50 · Bilateral: 150%
$1,777.10
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
69642 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 69641Tympanoplasty
- Both include tympanoplasty and mastoidectomy, but 69642 includes ossicular chain reconstruction; 69641 does not.
- 69643Tympanoplasty
- Compare the reconstruction details and prosthesis used. The neighboring code identifies the synthetic-prosthesis variant.
- 69645Tympanoplasty
- This code is for the radical or complete mastoidectomy variant, rather than the mastoidectomy extent represented by 69642.
- 69636Tympanoplasty
- 69636 includes tympanoplasty with ossicular reconstruction but not mastoidectomy. Choose 69642 when mastoidectomy is part of the operation.
69642 billing questions
When should 69642 be selected instead of 69641?
Use 69642 when the tympanoplasty and mastoidectomy include ossicular chain reconstruction. Code 69641 is the related option without chain reconstruction.
How does a synthetic prosthesis affect code selection?
Compare 69642 with 69643 when the reconstruction uses a synthetic prosthesis; the operative report should identify the reconstruction performed and materials used.
Can tympanoplasty without mastoidectomy be reported instead?
No, not when mastoidectomy is part of the service. Codes such as 69636 describe tympanoplasty without mastoidectomy and represent a different operative extent.
What documentation supports reporting 69642?
Document the mastoid and middle-ear disease, tympanic membrane repair, and the ossicular chain reconstruction. The operative report should make clear that all parts of the combined service were performed.
How are bilateral procedures and other same-session surgeries handled?
Modifier 50 applies to bilateral surgery, with payment at 150%. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%.
Is an assistant or co-surgeon payable for this operation?
Assistant-at-surgery payment is restricted for 69642. Co-surgeons and team surgery are not permitted.
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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