CPT code 42831: Adenoidectomy, primary, age 12 or older2026 Medicare rate & RVUs in New Mexico

In New Mexico, Medicare pays $206.49 for 42831 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42831 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 42831 covers

An otolaryngologist removes adenoid tissue located behind the nasal cavity, commonly to address nasal blockage, sleep-disordered breathing, or recurrent adenoid-related inflammation. The procedure is generally performed in a surgical facility under anesthesia. This code identifies a primary adenoidectomy in a patient who is at least 12 years old; it is not the code for repeat removal of residual or regrown tissue.

Choose the code based on the patient’s age and whether the adenoidectomy is primary or secondary. The operative report should support removal of adenoid tissue and the procedure’s primary status. CMS treats the service as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same 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 New Mexico compares for 42831

Across 109 of 109 payment localities, the facility rate for 42831 runs from $191.07 in Arkansas to $264.32 in San Benito County, CA. New Mexico pays $206.49. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42831 rates by state

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

See 42831 in every payment locality

How the 42831 rate is calculated

Each of 42831’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 42831

42831 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 42831

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

How 42831 has changed in New Mexico

Price 42831 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