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See a sample rate comparisonCPT 42971 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Control Nose Throat Bleeding, Control Of Nasopharyngeal Hemorrhage Primary Or Secondary Eg Postadenoidectomy Complicated Requiring Hospitalization
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Digestive System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | 58 - Staged or related procedure during postoperative period 78 - Return to OR - related procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $399.81 national non-facility rate (2026) · View Medicare rates for 42971 |
| Medicaid Fee Schedule | $323.18 median of the 8 states in the free preview · View Medicaid rates for 42971 |
National average reimbursement for CPT 42971 by major payers:
$599.59
$609.31
$630.66
$742.82
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CPT 42971
5 of 25 sample ratesHigher to lower in this preview
Ridgeline Surgicenter, LLC
$2,932.00Published rateSurgcenter Of Greater Jacksonville, LLC
Surgcenter Of Greater Jacksonville LLC
$983.00Published rateEast Brunswick Surgery Center LLC, University Surgicenter
East Brunswick Surgery Center
$610.00Published rateKuresmart Pain Management Surgery Center-Columbia LLC, Clearway Surgery Center Of Columbia
Kuresmart Pain Management Surgery Centercolumbia LLC
$384.00Published ratePhoenix Eye Surgical Center Plc, Central Phoenix Surgical Center
Phoenix Eye Surgical Center Pl
$200.00Published rate
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See a sample payer proposalCPT 42971 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 42971 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 42971 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 42960-CPT | Moderate | Control Oropharyngeal Hemorrha, Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg Posttonsillectomy) Simple Control Oropharyngeal Hemorrhage Primary Or Secondary (Eg |
| 42970-CPT | Moderate | Control Of Nasopharyngeal Hemo, Control Of Nasopharyngeal Hemorrhage Primary Or Secondary(Eg Postadenoidectomy) Simple With Posterior Nasal Packs With Or Without Anterior Packsandor Cauterization |
| 42971-CPT | Moderate | Control Nose Throat Bleeding, Control Of Nasopharyngeal Hemorrhage Primary Or Secondary Eg Postadenoidectomy Complicated Requiring Hospitalization |
| 42972-CPT | Moderate | Control Nose Throat Bleeding, Control Of Nasopharyngeal Hemorrhage Primary Or Secondary Eg Postadenoidectomy With Secondary Surgical Intervention |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 42971. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 42971 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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