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CPT code 42870: Tonsil excision, lingual tonsil2026 Medicare rate & RVUs

Reports surgical removal of lingual tonsil tissue, commonly for substantial enlargement at the tongue base contributing to airway obstruction or related symptoms.

CMS RVU26DEffective Oct 1, 2026109 payment localities153 Medicare services in 2024

Medicare pays $548.44 for 42870 nationally in a facility.

Medicare rate · 42870

Tonsil excision, lingual tonsil

Office or facility?

Work RVUs
5.38
Total RVUs
16.42
Global days
090

National rate · 2026

$548.44

Facility setting, before claim adjustments.

See every locality for 42870 →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 42870 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 42870 covers

An otolaryngologist removes lingual tonsil tissue at the base of the tongue, usually in an operating-room setting. The service may be performed for enlarged lingual tonsils associated with airway obstruction, including in a patient being evaluated or treated for obstructive sleep apnea. The operative report should identify the lingual tonsil as the target and describe the excision; removal of palatine tonsils or a biopsy of throat tissue is a different service.

Report this code when lingual tonsil tissue is excised, not when tissue is only sampled. Documentation should establish the operative site and extent of removal. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. 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 42870 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

42870 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$494.20
AlaskaUnavailable$648.70
ArizonaUnavailable$534.03
ArkansasUnavailable$487.37
Atlanta, GAUnavailable$559.76
Austin, TXUnavailable$565.65
Bakersfield, CAUnavailable$574.41
Baltimore area, MDUnavailable$582.56
Beaumont, TXUnavailable$515.76
Brazoria, TXUnavailable$540.99

42870 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
42870 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 42870 rate is calculated

Each of 42870’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 · 42870

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.38

5.38 RVUs× 1.000 GPCI

Practice expense10.25

10.25 RVUs× 1.000 GPCI

Malpractice0.79

0.79 RVUs× 1.000 GPCI

Adjusted RVUs

16.4200

Conversion factor

$33.4009

Medicare rate

$548.44

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

Payment rules and modifiers for 42870

42870 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42870

Tonsil excision, lingual tonsil

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 · 42870

Tonsil excision, lingual tonsil

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

42870 without 51 · national facility

$548.44

Tonsil excision, lingual tonsil

42870-51 · Second procedure: 50%

$274.22

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

42870 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 42870

    Tonsil excision, lingual tonsil5.38 wRVU

    Not priced

  • 42800

    Biopsy, pharynx tissue sampling1.4 wRVU

    $159.66

  • 42808

    Pharyngeal lesion treatment, excision or destruction2.29 wRVU

    $234.47

  • 42825

    Tonsillectomy, younger than age 123.42 wRVU

    Not priced

  • 42826

    Tonsillectomy, age 12 or older3.36 wRVU

    Not priced

How to choose

42800BiopsyPharynx tissue sampling
Use 42800 for diagnostic biopsy of throat tissue. Use 42870 when lingual tonsil tissue is excised rather than sampled.
42808Pharyngeal lesion treatmentExcision or destruction
42808 addresses excision of a pharyngeal lesion. This code is specific to removal of lingual tonsil tissue at the tongue base.
42825TonsillectomyYounger than age 12
42825 is for removal of palatine tonsils in a younger patient. Choose 42870 when the operative target is the lingual tonsil.
42826TonsillectomyAge 12 or older
42826 is for removal of palatine tonsils in an older patient. It does not describe excision of lingual tonsil tissue.

Codes related to 42870

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

Codes related to 42870
CodeHow it relatesNational office range
Used instead
42800Biopsy, pharynx tissue samplingThroat-tissue sampling is a different service when diagnosis, rather than lingual tonsil removal, is intended.$141.33–$208.34
42825Tonsillectomy, younger than age 12Applies to palatine tonsil removal in a younger patient, not excision of lingual tonsil tissue.No office rate
42826Tonsillectomy, age 12 or olderApplies to palatine tonsil removal in an older patient, not excision of lingual tonsil tissue.No office rate

42870 billing questions

How is this different from palatine tonsillectomy?

This code is for lingual tonsil tissue at the tongue base. Palatine tonsillectomy codes apply to the tonsils on the sides of the throat.

Can this code be used for a biopsy?

No. It reports excision of lingual tonsil tissue. A throat-tissue biopsy is a different service when the intent is diagnostic sampling rather than removal.

Should modifier 50 be appended for both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction.

When may an assistant at surgery be reported?

Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.

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 42870PPRRVU2026_Oct_nonQPP.csv, line 5,091 (RVU26D)

Open CMS sourceHow we calculate rates

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