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CPT code 42836: Adenoid removal, secondary, age 12 or older2026 Medicare rate & RVUs

Repeat adenoid removal in patients age 12 or older is reported when residual or recurrent adenoid tissue is surgically removed after an earlier adenoidectomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities16 Medicare services in 2024

Medicare pays $222.78 for 42836 nationally in a facility.

Medicare rate · 42836

Adenoid removal, secondary, age 12 or older

Office or facility?

Work RVUs
3.18
Total RVUs
6.67
Global days
090

National rate · 2026

$222.78

Facility setting, before claim adjustments.

See every locality for 42836 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 42836 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 42836 covers

An otolaryngologist removes residual or recurrent adenoid tissue in a patient age 12 or older who has had a prior adenoidectomy. The repeat operation may be considered when remaining or regrown tissue contributes to nasal obstruction, sleep-disordered breathing, or other symptoms. It is generally performed in an operating-room setting. The operative report should establish that this is a secondary procedure and describe the tissue removed and the reason for repeat surgery.

Report this code for secondary adenoid removal in a patient age 12 or older; a primary procedure or a patient under 12 falls into a different code. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure 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.

Where 42836 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

42836 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$203.47
AlaskaUnavailable$275.57
ArizonaUnavailable$217.43
ArkansasUnavailable$201.06
Atlanta, GAUnavailable$227.81
Austin, TXUnavailable$227.11
Bakersfield, CAUnavailable$228.51
Baltimore area, MDUnavailable$235.51
Beaumont, TXUnavailable$212.58
Brazoria, TXUnavailable$219.34

42836 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
42836 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 42836 rate is calculated

Each of 42836’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.

How the rate is built · 42836

RVUs × geographic indexes × conversion factor

Office or facility?

Work3.18

3.18 RVUs× 1.000 GPCI

Practice expense3.03

3.03 RVUs× 1.000 GPCI

Malpractice0.46

0.46 RVUs× 1.000 GPCI

Adjusted RVUs

6.6700

Conversion factor

$33.4009

Medicare rate

$222.78

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 42836

42836 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42836

Adenoid removal, secondary, age 12 or older

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.09/0.81/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 42836

Adenoid removal, secondary, age 12 or older

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42836 without 51 · national facility

$222.78

Adenoid removal, secondary, age 12 or older

42836-51 · Second procedure: 50%

$111.39

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

42836 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 42836

    Adenoid removal, secondary, age 12 or older3.18 wRVU

    Not priced

  • 42835

    Adenoid removal, secondary, under age 122.32 wRVU

    Not priced

  • 42831

    Adenoidectomy, primary, age 12 or older2.74 wRVU

    Not priced

  • 42821

    Tonsil and adenoid removal, age 12 or older4.25 wRVU

    Not priced

How to choose

42835Adenoid removalSecondary, under age 12
Both describe secondary adenoid removal; use 42835 for patients under 12 and 42836 for patients 12 or older.
42831AdenoidectomyPrimary, age 12 or older
Both apply to patients age 12 or older. Use 42831 for primary adenoid surgery and 42836 when the patient has had prior adenoid surgery.
42821Tonsil and adenoid removalAge 12 or older
42821 represents removal of both tonsils and adenoids in a patient age 12 or older. Use 42836 when the repeat procedure is limited to adenoid tissue.

Codes related to 42836

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

Codes related to 42836
CodeHow it relatesNational office range
Same family
42835Adenoid removal, secondary, under age 12Secondary adenoid removal for a patient under age 12.No office rate
42830Adenoid removal, primary, younger than 12Primary adenoid removal for a patient under age 12.No office rate
Used instead
42831Adenoidectomy, primary, age 12 or olderPrimary adenoid removal for a patient age 12 or older.No office rate
42821Tonsil and adenoid removal, age 12 or olderCombined tonsil and adenoid removal for a patient age 12 or older.No office rate

42836 billing questions

How does this differ from 42831?

42836 is for secondary adenoid removal in a patient age 12 or older after prior adenoid surgery. 42831 is for a primary procedure in that age group.

When should 42835 be used instead?

Use 42835 for secondary adenoid removal in a patient under age 12. Age distinguishes it from 42836.

Can this be reported with tonsil removal?

If tonsils and adenoids are both removed in a patient age 12 or older, consider the combined procedure code 42821 rather than separately reporting adenoid removal and tonsillectomy.

What documentation supports secondary removal?

Document the prior adenoidectomy, the current residual or recurrent tissue, the clinical reason for repeat surgery, and the tissue addressed in the operative report.

Can modifier 50 be appended?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

When is an assistant-at-surgery payable?

CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeon and team-surgery payment is not permitted.

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

Show the CMS file lines behind this rate
RVUs for 42836PPRRVU2026_Oct_nonQPP.csv, line 5,086 (RVU26D)

Open CMS sourceHow we calculate rates

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