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

In Washington, DC area, Medicare pays $248.27 for 42836 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42836 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 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.

How Washington, DC area compares for 42836

Across 109 of 109 payment localities, the facility rate for 42836 runs from $201.06 in Arkansas to $275.57 in Alaska. Washington, DC area pays $248.27. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42836 rates by state

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

See 42836 in every payment locality

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

Codes related to 42836

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

How 42836 has changed in Washington, DC area

Price 42836 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

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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