No office rate
Choose 42960 for simple oropharyngeal bleeding control. 42961 is for complicated control requiring hospitalization.
On this page
CMS RVU26D · Effective 2026-10-01
42960 Throat bleeding control Medicare reimbursement rates in Washington
Reports straightforward control of bleeding in the oropharynx, commonly after tonsillectomy, when the episode does not require more complex intervention. Compare 42960 office and facility rates across CMS payment localities in Washington.
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 42960 in Washington?
Washington has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$146.64–$159.90
2 of 2 localities have a supported rate.
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 procedure
About 42960: Simple oropharyngeal bleeding control
Reports straightforward control of bleeding in the oropharynx, commonly after tonsillectomy, when the episode does not require more complex intervention.
CPT 42960 covers straightforward control of bleeding from the oropharynx, including bleeding that occurs during or after a throat procedure. A familiar situation is a post-tonsillectomy bleed treated with local hemostasis. An otolaryngologist or other physician managing the bleeding may perform the service in an office, emergency department, or surgical setting. The code describes control of the throat bleeding, not repair of a throat wound.
Select this level when the control is simple; cases requiring hospitalization for complicated bleeding or a secondary surgical procedure fall into different codes. Document the bleeding site, its cause when known, the hemostatic work performed, and the circumstances supporting the level selected. The 10-day global period includes related postoperative visits during that period. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42960
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.32 · 53%
- Practice expense (office) RVU1.67 · 38%
- Malpractice RVU0.37 · 8%
123
Medicare services in 2024 · #4717 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.
42960 compared with similar codes
Office rates for Washington, from the same CMS release.
No office rate
Choose 42962 when complicated oropharyngeal bleeding requires a secondary surgical procedure; 42960 represents simple control.
No office rate
42970 addresses posterior nasal bleeding control. Use 42960 when the bleeding site is the oropharynx.
Compare 42960 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.
2 of 2 payment localities
Rest Of Washington →
Office / nonfacility
Unavailable
Facility
$146.64
Seattle (King Cnty) →
Office / nonfacility
Unavailable
Facility
$159.90
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42960 billing questions
How does 42960 differ from 42961?
42960 is for simple control of oropharyngeal bleeding. Use 42961 for complicated control that requires hospitalization.
When is 42962 used instead?
42962 describes complicated oropharyngeal bleeding control that requires a secondary surgical procedure. It is not the simple-control level represented by 42960.
Are packing or cautery separately reported?
When packing or cautery is used as part of controlling the oropharyngeal bleed, it is a method of performing this service. Document the hemostatic work and the bleeding site.
Can modifier 50 be appended for bleeding on both sides?
No. CMS indicates that bilateral adjustment does not apply to this code, so modifier 50 is inappropriate.
Are related follow-up visits included?
Related postoperative visits during the 10-day global period are included in the procedure's payment.
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.
5,09842950,,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
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