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CPT code 42825: Tonsillectomy, younger than age 122026 Medicare rate & RVUs

Reports surgical removal of the palatine tonsils in a patient younger than 12, commonly for recurrent infection or tonsillar obstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $243.49 for 42825 nationally in a facility.

Medicare rate · 42825

Tonsillectomy, younger than age 12

Office or facility?

Work RVUs
3.42
Total RVUs
7.29
Global days
090

National rate · 2026

$243.49

Facility setting, before claim adjustments.

See every locality for 42825 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 42825 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 42825 covers

An otolaryngologist typically performs this operation in an operating room, removing the palatine tonsils in a patient younger than 12. Common clinical reasons include recurrent or chronic tonsillitis and enlarged tonsils associated with obstructive breathing or sleep-disordered breathing. The operation addresses the tonsils; removal of adenoid tissue is a separate distinction in code selection.

Select this code based on the patient’s age on the date of surgery and the documented procedure. The operative report should support removal of the palatine tonsils and identify any additional procedure, such as adenoid removal. This major surgery includes the preoperative visit on the day before and related postoperative care for 90 days. For multiple procedures in the same session, CMS pays the highest-valued procedure in full and other procedures at 50%. Do not append modifier 50. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery 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 42825 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42825 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$222.38
AlaskaUnavailable$300.77
ArizonaUnavailable$237.67
ArkansasUnavailable$219.75
Atlanta, GAUnavailable$248.87
Austin, TXUnavailable$248.46
Bakersfield, CAUnavailable$250.26
Baltimore area, MDUnavailable$257.39
Beaumont, TXUnavailable$232.16
Brazoria, TXUnavailable$239.86

42825 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
42825 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 42825 rate is calculated

Each of 42825’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 · 42825

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.42

3.42 RVUs× 1.000 GPCI

Practice expense3.39

3.39 RVUs× 1.000 GPCI

Malpractice0.48

0.48 RVUs× 1.000 GPCI

Adjusted RVUs

7.2900

Conversion factor

$33.4009

Medicare rate

$243.49

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 42825

42825 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42825

Tonsillectomy, younger than age 12

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42825

Tonsillectomy, younger than age 12

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42825 without 51 · national facility

$243.49

Tonsillectomy, younger than age 12

42825-51 · Second procedure: 50%

$121.75

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%).

When to use modifier 51

42825 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 42825

    Tonsillectomy, younger than age 123.42 wRVU

    Not priced

  • 42826

    Tonsillectomy, age 12 or older3.36 wRVU

    Not priced

  • 42820

    Tonsil and adenoid removal, patient younger than 124.11 wRVU

    Not priced

  • 42830

    Adenoid removal, primary, younger than 122.58 wRVU

    Not priced

How to choose

42826TonsillectomyAge 12 or older
The procedure is tonsil removal in both codes; age determines the choice. Use 42825 below age 12 and 42826 at age 12 or older.
42820Tonsil and adenoid removalPatient younger than 12
This code includes removal of both tonsils and adenoids in a patient younger than 12. Choose 42825 when the documented operation removes the tonsils only.
42830Adenoid removalPrimary, younger than 12
This code reports adenoid removal without tonsil removal. It is not the choice when the surgeon removes the palatine tonsils.

Codes related to 42825

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

Codes related to 42825
CodeHow it relatesNational office range
Same family
42826Tonsillectomy, age 12 or olderTonsil removal for patients age 12 or older.No office rate
Used instead
42820Tonsil and adenoid removal, patient younger than 12For patients younger than 12 when the surgeon also removes adenoid tissue.No office rate
42821Tonsil and adenoid removal, age 12 or olderCombined tonsil and adenoid removal for patients age 12 or older.No office rate
42830Adenoid removal, primary, younger than 12Adenoid removal alone when the tonsils are not removed.No office rate

42825 billing questions

How does this code differ from 42826?

Both report tonsil removal, but 42825 is for patients younger than 12. Use 42826 for patients age 12 or older.

Can modifier 50 be reported for removal of both tonsils?

No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.

When should 42820 be considered instead?

Use 42820 when the surgeon removes both the tonsils and adenoids in a patient younger than 12. This code covers tonsil removal without the adenoid procedure.

What documentation supports reporting 42825?

The operative report should document removal of the palatine tonsils, and the record should establish that the patient was younger than 12 on the surgery date.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and related postoperative care during the 90 days after surgery are included in the global period.

Can an assistant surgeon be reported?

Assistant-at-surgery payment is available only when the record documents medical necessity. 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
RVUs for 42825PPRRVU2026_Oct_nonQPP.csv, line 5,081 (RVU26D)

Open CMS sourceHow we calculate rates

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