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

In New Mexico, Medicare pays $237.32 for 42825 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42825 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 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.

How New Mexico compares for 42825

Across 109 of 109 payment localities, the facility rate for 42825 runs from $219.75 in Arkansas to $300.77 in Alaska. New Mexico pays $237.32. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42825 rates by state

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

See 42825 in every payment locality

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.

Payment rules and modifiers for 42825

42825 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 42825

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

How 42825 has changed in New Mexico

Price 42825 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

• Abeytas
• Abiquiu
• Acomita Lake
• Adelino
• Agua Fria
• Alamillo
• Alamo
• Alamogordo

Browse all communities in New Mexico

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