No office rate
This code family addresses bleeding in the oropharynx, such as a tonsillar-bed source. Use 42970 for nasopharyngeal bleeding controlled with packing.
On this page
CMS RVU26D · Effective 2026-10-01
42970 Bleeding control Medicare reimbursement rates in Wisconsin
Reports operative control of primary or recurrent bleeding from the nasopharynx when packing is used, including hemorrhage following adenoid surgery. Compare 42970 office and facility rates across CMS payment localities in Wisconsin.
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 42970 in Wisconsin?
Wisconsin 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
$339.03
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 42970: Nasopharyngeal hemorrhage control with packing
Reports operative control of primary or recurrent bleeding from the nasopharynx when packing is used, including hemorrhage following adenoid surgery.
This service controls bleeding in the nasopharynx using packing. It may be needed for primary bleeding or a later hemorrhage, including bleeding after adenoidectomy. An otolaryngologist typically performs the intervention in a hospital or other facility when the bleeding requires procedural control. The documented source should be nasopharyngeal; bleeding confined to the oropharynx is coded from a different family.
Report 42970 when packing is the method used to control the nasopharyngeal hemorrhage. The record should identify the bleeding site, whether the episode is primary or recurrent, the packing intervention, and the clinical circumstances. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 42970
- 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
- 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 RVU5.67 · 52%
- Practice expense (office) RVU4.41 · 40%
- Malpractice RVU0.83 · 8%
13
Medicare services in 2024 · #6127 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.
42970 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
Both codes address nasopharyngeal hemorrhage, but the selected code depends on the control method documented. 42970 is the packing-based service.
$373.08
This code is for initial control of posterior epistaxis. Use 42970 when the service is control of nasopharyngeal hemorrhage with packing, rather than a posterior-epistaxis service.
Compare 42970 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$339.03
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 42970 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
5,104
- Code
- 42970
- Physician work
- 5.67
- Practice expense
- 4.41
- Malpractice
- 0.83
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.67 | × 1.000 | 5.6700 |
| Practice expense | 4.41 | × 0.958 | 4.2248 |
| Malpractice | 0.83 | × 0.308 | 0.2556 |
| Total RVUs | 10.1504 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$339.03
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.67 | 1 |
| Practice expense | 4.41 | 0.958 |
| Malpractice | 0.83 | 0.308 |
(5.67 × 1 + 4.41 × 0.958 + 0.83 × 0.308) × $33.4009 = $339.03
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.
42970 billing questions
How does 42970 differ from codes 42971 and 42972?
These are sibling codes for control of nasopharyngeal hemorrhage, distinguished by the intervention used. Report 42970 when packing is used; select the sibling matching the documented method for other approaches.
Can 42970 be used for bleeding after tonsillectomy?
Use this code for a nasopharyngeal source controlled with packing. Hemorrhage arising in the oropharynx, such as a tonsillar-bed bleed, belongs to the 42960–42962 code family.
Is packing separately reported with 42970?
Packing is the defining intervention for this service. Do not report it again as a separate service for the same hemorrhage-control work.
Does modifier 50 apply when both sides are packed?
No. CMS indicates that bilateral adjustment does not apply and modifier 50 is inappropriate for this code.
What postoperative services are included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care. CMS also applies the standard multiple-procedure reduction when other procedures are performed in the same session.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for 42970, and 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 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.
5,10142960,,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,