CPT code 42821: Tonsil and adenoid removal, age 12 or older2026 Medicare rate & RVUs in Kentucky

In Kentucky, Medicare pays $258.29 for 42821 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42821 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 42821 covers

An otolaryngologist removes the palatine tonsils and adenoid tissue during the same operation. Common clinical settings include surgery for recurrent tonsillitis or adenotonsillar enlargement associated with obstructive sleep-disordered breathing. The code applies when the patient is 12 or older and both sites are treated; tonsil removal alone or adenoid removal alone calls for a different code. These procedures are typically performed in a facility operating room.

The operative report should identify the patient’s age and document removal of both the tonsils and adenoids, along with the clinical reason. The combined procedure is reported as one service rather than as separate tonsil and adenoid procedures. It has a 90-day global period, including the day-before preoperative visit and related postoperative care. For other procedures performed in the same session, the highest-valued procedure is paid in full and additional procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeon and team-surgery billing are not permitted.

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 Kentucky compares for 42821

Across 109 of 109 payment localities, the facility rate for 42821 runs from $246.84 in Arkansas to $341.19 in Alaska. Kentucky pays $258.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42821 rates by state

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

See 42821 in every payment locality

How the 42821 rate is calculated

Each of 42821’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 42821

42821 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 42821

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

How 42821 has changed in Kentucky

Price 42821 for an earlier date of service

Where the Kentucky rate applies

Kentucky is a Medicare payment area, not a city. Our Census mapping connects it to 553 cities and communities in Kentucky. Some span more than one payment area; confirm with the service ZIP.

• Adairville
• Ages
• Albany
• Alexandria
• Allen
• Allensville
• Anchorage
• Annville

Browse all communities in Kentucky

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