No office rate
This code concerns repair involving the pharynx or cervical esophagus through a cervical approach. Code 42900 is for repair of a throat wound.
On this page
CMS RVU26D · Effective 2026-10-01
42953 Throat repair Medicare reimbursement rates in Vermont
Reports operative repair of a pharyngeal or cervical esophageal defect, including repair involving a tracheoesophageal fistula, through a cervical approach. Compare 42953 office and facility rates across CMS payment localities in Vermont.
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 42953 in Vermont?
Vermont 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
$865.16
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
ENT surgery
About 42953: Cervical pharynx or esophagus repair
Reports operative repair of a pharyngeal or cervical esophageal defect, including repair involving a tracheoesophageal fistula, through a cervical approach.
This operation repairs a defect involving the pharynx or the cervical portion of the esophagus through an incision in the neck. It may include closure of a tracheoesophageal fistula, an abnormal connection between the trachea and esophagus. An otolaryngologist or head and neck surgeon commonly performs the procedure in an operating room; a surgeon managing the esophageal defect may also perform it. The operative report should identify the repaired anatomy, the cervical approach, and whether a fistula was repaired.
Report the code when the documented operation matches this anatomic scope and approach, rather than a wound suture, pharyngeal reconstruction, or esophagoplasty described by another code. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42953
- 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 RVU9.21 · 34%
- Practice expense (office) RVU16.13 · 60%
- Malpractice RVU1.43 · 5%
150
Medicare services in 2024 · #4564 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.
42953 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
Code 42950 describes pharyngoplasty. Choose this code when the documented operation is repair involving the pharynx or cervical esophagus, with or without fistula repair.
No office rate
Code 43300 is the cervical esophagoplasty comparison. Select the code that matches the documented operation and anatomy rather than choosing solely by the cervical approach.
No office rate
Code 42955 concerns pharyngotomy with exploration or foreign-body removal; this code is for repair of a pharyngeal or cervical esophageal defect.
Compare 42953 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
Vermont →
Office / nonfacility
Unavailable
Facility
$865.16
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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 42953 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,099
- Code
- 42953
- Physician work
- 9.21
- Practice expense
- 16.13
- Malpractice
- 1.43
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.21 | × 1.000 | 9.2100 |
| Practice expense | 16.13 | × 0.990 | 15.9687 |
| Malpractice | 1.43 | × 0.506 | 0.7236 |
| Total RVUs | 25.9023 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$865.16
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 9.21 | 1 |
| Practice expense | 16.13 | 0.99 |
| Malpractice | 1.43 | 0.506 |
(9.21 × 1 + 16.13 × 0.99 + 1.43 × 0.506) × $33.4009 = $865.16
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.
42953 billing questions
When should this code be chosen instead of a throat-wound repair code?
Use this code for an operative repair involving the pharynx or cervical esophagus through a cervical approach, with or without fistula repair. A repair limited to a throat wound may fit the wound-repair code instead.
How does this differ from cervical esophagoplasty?
Choose based on the operation documented and the code descriptor that fits it. This code encompasses repair involving the pharynx or cervical esophagus, while cervical esophagoplasty is the relevant comparison when the operation is described as esophageal reconstruction.
Is postoperative care billed separately during the global period?
Related postoperative care is included in the 90-day global period, along with the day-before preoperative visit.
Can modifier 50 or an assistant surgeon be reported?
Modifier 50 is inappropriate for this code. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.
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.
5,0964290F,,Pt scrned for inj drug use,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
5,0974293F,,Pt scrnd hgh-risk sex behav,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
5,09842950,,Reconstruction of throat,A,,8.06,12.69,NA,12.69,,1.20,21.95,21.95,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,09942953,,Repair throat esophagus,A,,9.21,16.13,NA,16.13,,1.43,26.77,26.77,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10042955,,Surgical opening of throat,A,,7.81,11.91,NA,11.91,,1.14,20.86,20.86,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10142960,,Control throat bleeding,A,,2.32,1.67,NA,1.67,,0.37,4.36,4.36,0,010,0.10,0.80,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,10242961,,Control throat bleeding,A,,5.63,4.71,NA,4.71,,0.82,11.16,11.16,0,090,0.09,0.81,0.10,2,0,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817