CPT code 42830: Adenoid removal, primary, younger than 122026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $196.27 for 42830 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42830 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 42830 covers

An otolaryngologist removes adenoid tissue from the nasopharynx during a first adenoid operation for a patient younger than 12. Common clinical reasons include enlarged adenoids contributing to nasal obstruction, sleep-disordered breathing, or recurrent adenoid-related symptoms. The procedure is generally performed in an operating room under anesthesia; the operative report should establish that adenoid tissue was removed and whether this was the patient’s first adenoid operation.

Select this code for a primary adenoid procedure in a patient younger than 12. When tonsils are also removed in the same operation, use the age-appropriate combined tonsil-and-adenoid code rather than reporting this code as the adenoid portion. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented 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 Puerto Rico compares for 42830

Across 109 of 109 payment localities, the facility rate for 42830 runs from $175.63 in Arkansas to $241.65 in San Benito County, CA. Puerto Rico pays $196.27. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42830 rates by state

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

See 42830 in every payment locality

How the 42830 rate is calculated

Each of 42830’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 42830

42830 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 42830

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

How 42830 has changed in Puerto Rico

Price 42830 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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