No office rate
42960 covers simple control of oropharyngeal hemorrhage. Choose 42961 when the complicated episode requires hospitalization.
On this page
CMS RVU26D · Effective 2026-10-01
42961 Hemorrhage control Medicare reimbursement rates in Vermont
Reports operative control of complicated oropharyngeal bleeding that requires hospitalization, such as significant post-tonsillectomy hemorrhage requiring surgical hemostasis. Compare 42961 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 42961 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
$357.65
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.
Otolaryngology surgery
About 42961: Complicated oropharyngeal hemorrhage control
Reports operative control of complicated oropharyngeal bleeding that requires hospitalization, such as significant post-tonsillectomy hemorrhage requiring surgical hemostasis.
An otolaryngologist typically reports this service when controlling complicated bleeding from the oropharynx, including significant hemorrhage after tonsillectomy that requires hospitalization. The procedure may involve operative hemostasis, such as cauterizing or ligating the bleeding source. The code level is based on the documented complexity and hospitalization requirement, not simply on the presence of bleeding.
Choose 42961 when the complicated hemorrhage requires hospitalization; 42962 is the sibling code when hospitalization and general anesthesia are required. The record should identify the bleeding site, clinical circumstances, treatment performed, and reason hospitalization was required. This major surgery code includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are reduced to 50%. Bilateral adjustment is not appropriate. An assistant at surgery may be paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 42961
- 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 RVU5.63 · 50%
- Practice expense (office) RVU4.71 · 42%
- Malpractice RVU0.82 · 7%
59
Medicare services in 2024 · #5256 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.
42961 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
42962 applies when complicated hemorrhage requires hospitalization and general anesthesia; 42961 is for the hospitalization-level service without that added criterion.
No office rate
42970 is in the nose/throat hemorrhage-control group. Select based on the applicable bleeding site and procedure rather than treating it as the oropharyngeal hemorrhage code.
Compare 42961 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
$357.65
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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 42961 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
5,102
- Code
- 42961
- Physician work
- 5.63
- Practice expense
- 4.71
- Malpractice
- 0.82
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.63 | × 1.000 | 5.6300 |
| Practice expense | 4.71 | × 0.990 | 4.6629 |
| Malpractice | 0.82 | × 0.506 | 0.4149 |
| Total RVUs | 10.7078 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$357.65
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.63 | 1 |
| Practice expense | 4.71 | 0.99 |
| Malpractice | 0.82 | 0.506 |
(5.63 × 1 + 4.71 × 0.99 + 0.82 × 0.506) × $33.4009 = $357.65
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.
42961 billing questions
How does 42961 differ from 42960?
42961 is for complicated oropharyngeal hemorrhage requiring hospitalization. Use 42960 for simple control of primary or secondary oropharyngeal hemorrhage.
When is 42962 the better choice?
Use 42962 when the complicated hemorrhage requires both hospitalization and general anesthesia. Document the circumstances supporting those requirements.
What documentation supports 42961?
Document the oropharyngeal bleeding site, the control procedure performed, the complexity of the hemorrhage, and why hospitalization was required.
Should modifier 50 be reported for bilateral bleeding?
No. CMS bilateral adjustment does not apply to 42961, and modifier 50 is inappropriate for this code.
Can an assistant or another surgeon be reported?
An assistant at surgery may be paid. Co-surgeons and team surgery are not permitted for this code.
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.
5,09942953,,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
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
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