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

In South Dakota, Medicare pays $530.92 for 42870 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 42870 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 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.

How South Dakota compares for 42870

Across 109 of 109 payment localities, the facility rate for 42870 runs from $487.37 in Arkansas to $707.29 in San Benito County, CA. South Dakota pays $530.92. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

42870 rates by state

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

See 42870 in every payment locality

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.

Payment rules and modifiers for 42870

42870 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 42870

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

How 42870 has changed in South Dakota

Price 42870 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

• Aberdeen
• Agar
• Agency Village
• Akaska
• Albee
• Alcester
• Alexandria
• Allen

Browse all communities in South Dakota

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