CPT code 42820: Tonsil and adenoid removal, patient younger than 122026 Medicare rate & RVUs in Nevada

In Nevada, Medicare pays $257.67 for 42820 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42820 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 42820 covers

The operation removes the palatine tonsils and adenoid tissue during the same session. Otolaryngologists commonly perform it for recurrent tonsillitis or sleep-disordered breathing associated with enlarged adenotonsillar tissue. The procedure is generally performed in a hospital or ambulatory surgery center, often under general anesthesia.

Select this code when the patient is younger than 12 on the date of surgery and both tonsils and adenoids are removed. The operative report should identify both tissues removed, the clinical indication, and the service date. Tonsillectomy alone or adenoidectomy alone is reported with the code for that procedure instead. This major surgery has a 90-day global period that includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Report the combined operation once; modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity. CMS does not recognize co-surgeon or team-surgery billing for this code.

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.

How Nevada compares for 42820

Across 109 of 109 payment localities, the facility rate for 42820 runs from $236.66 in Arkansas to $327.40 in Alaska. Nevada pays $257.67. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42820 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 42820 in every payment locality

How the 42820 rate is calculated

Each of 42820’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 42820

42820 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

Codes related to 42820

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 42820 has changed in Nevada

Price 42820 for an earlier date of service

Where the Nevada rate applies

Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.

• Alamo
• Amargosa Valley
• Austin
• Baker
• Battle Mountain
• Beatty
• Beaverdam
• Bennett Springs

Browse all communities in Nevada

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates