CPT code 42826: Tonsillectomy, age 12 or older2026 Medicare rate & RVUs in Nevada

In Nevada, Medicare pays $228.89 for 42826 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42826 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 42826 covers

This code describes surgical removal of the palatine tonsils in a patient who is at least 12 on the date of surgery. Otolaryngologists commonly perform the procedure in a hospital or ambulatory surgery center, often for recurrent tonsillar infections or obstructive tonsillar enlargement. It covers tonsil removal without the adenoidectomy included in a combined tonsil-and-adenoid procedure.

Choose the age-specific code based on the patient’s age on the service date; use the under-12 tonsillectomy code for younger patients. The operative report should support removal of the palatine tonsils and document the indication and any concurrent adenoid procedure. Medicare includes the day-before preoperative visit and 90 days of related postoperative care in the major-surgery global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery; 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 Nevada compares for 42826

Across 109 of 109 payment localities, the facility rate for 42826 runs from $209.14 in Arkansas to $287.09 in Alaska. Nevada pays $228.89. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42826 rates by state

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

See 42826 in every payment locality

How the 42826 rate is calculated

Each of 42826’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 42826

42826 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 42826

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

How 42826 has changed in Nevada

Price 42826 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