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

CMS doesn’t publish an office rate for 42836 in California.

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

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 in California

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

29 of 29 payment localities

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.

Payment rules and modifiers for 42836

42836 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

42836 compared with similar codes

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.

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