CPT code 42821: Tonsil and adenoid removal, age 12 or older2026 Medicare rate & RVUs in Missouri
Reports removal of both the tonsils and adenoids in a patient age 12 or older, commonly for recurrent infection or obstructive symptoms.
CMS doesn’t publish an office rate for 42821 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Where 42821 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $265.05 |
| Metropolitan St. Louis, MO | Unavailable | $266.98 |
| Rest of Missouri | Unavailable | $256.52 |
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.
How the rate is built · 42821
RVUs × geographic indexes × conversion factor
Work4.25
4.25 RVUs× 1.000 GPCI
Practice expense3.29
3.29 RVUs× 1.000 GPCI
Malpractice0.61
0.61 RVUs× 1.000 GPCI
Adjusted RVUs
8.1500
Conversion factor
$33.4009
Medicare rate
$272.22
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42821
42821 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42821
Tonsil and adenoid removal, age 12 or older
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42821
Tonsil and adenoid removal, age 12 or older
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42821 without 51 · national facility
$272.22
Tonsil and adenoid removal, age 12 or older
42821-51 · Second procedure: 50%
$136.11
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
42821 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 42820Tonsil and adenoid removalPatient younger than 12
- Use 42820 for combined tonsil and adenoid removal in a patient younger than 12; 42821 is for age 12 or older.
- 42826TonsillectomyAge 12 or older
- 42826 covers tonsil removal alone in a patient age 12 or older. Use 42821 when adenoid tissue is also removed.
- 42831AdenoidectomyPrimary, age 12 or older
- 42831 covers primary adenoid removal alone in a patient age 12 or older. Use 42821 when the tonsils are removed during the same operation.
42821 billing questions
How does this code differ from 42820?
Both codes cover removal of tonsils and adenoids in the same operation. Use 42821 for patients age 12 or older; 42820 is for patients younger than 12.
Can tonsil and adenoid removal be billed as separate procedures?
When both are removed in the same operation for a patient age 12 or older, report the combined service. Use a tonsil-only or adenoid-only code when only that tissue is removed.
Should modifier 50 be appended?
No. The bilateral adjustment does not apply to this service, and modifier 50 is inappropriate for the paired tonsils.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
When can an assistant surgeon be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. 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 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
Show the CMS file lines behind this rate
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