CPT code 42835: Adenoid removal, secondary, under age 122026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $184.23 for 42835 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42835 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 42835 covers

An otolaryngologist performs this repeat operation when adenoid tissue remains or regrows after an earlier adenoidectomy and is causing a clinical problem, such as nasal obstruction or sleep-disordered breathing. The procedure is generally performed in an operating room under anesthesia. The age qualifier is younger than 12; the secondary designation distinguishes it from an initial adenoid operation.

The operative report should establish the patient’s age, prior adenoid surgery, the recurrent or residual tissue addressed, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. 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% reduction. A bilateral adjustment is inappropriate for this service. 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 42835

Across 109 of 109 payment localities, the facility rate for 42835 runs from $164.42 in Arkansas to $228.10 in San Benito County, CA. Puerto Rico pays $184.23. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42835 rates by state

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

See 42835 in every payment locality

How the 42835 rate is calculated

Each of 42835’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 42835

42835 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 42835

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

How 42835 has changed in Puerto Rico

Price 42835 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