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CPT code 42999: Unlisted throat procedure, pharynx, adenoids, or tonsils2026 Medicare rate & RVUs

An unlisted surgical code for procedures involving the pharynx, adenoids, or tonsils when no specific CPT code describes the work performed.

CMS RVU26DEffective Oct 1, 2026109 payment localities295 Medicare services in 2024

Medicare rate · 42999

Unlisted throat procedure, pharynx, adenoids, or tonsils

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
YYY

National rate · 2026

—

Not priced in the facility setting.

See every locality for 42999 →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 42999 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 42999 covers

CPT 42999 is used for an operation involving the pharynx, adenoids, or tonsils when no more specific CPT code describes the service. Otolaryngologists and head-and-neck surgeons may report it for uncommon operative work in these areas. It is not the selection for a routine, specifically described tonsillectomy, adenoidectomy, or combined procedure when a listed code fits. The claim should identify the procedure performed and include an operative report explaining the work and why a listed code does not describe it.

Medicare assigns this code physician fee schedule status C, or carrier priced: there is no national payment amount, and the Medicare Administrative Contractor sets payment for each claim. The contractor also sets the global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are reduced to 50%.

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 42999 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

42999 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

42999 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
42999 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 42999 rate is calculated

Each of 42999’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 · 42999

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

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

Payment rules and modifiers for 42999

The CMS indicators that decide how 42999 is paid alongside other services.

CMS payment indicators · 42999

Unlisted throat procedure, pharynx, adenoids, or tonsils

RuleCMS valueWhat it means
Global periodYYYThe Medicare contractor sets the global period.
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)1Permitted with supporting documentation.
Team surgery (66)1Permitted with supporting documentation.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

42999 without 51 · national facility

$0.00

Unlisted throat procedure, pharynx, adenoids, or tonsils

42999-51 · Second procedure: 50%

$0.00

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

42999 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 42999

    Unlisted throat procedure, pharynx, adenoids, or tonsils0 wRVU

    Not priced

  • 42820

    Tonsil and adenoid removal, patient younger than 124.11 wRVU

    Not priced

  • 42821

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

    Not priced

  • 42900

    Pharyngeal repair, wound closure5.16 wRVU

    Not priced

  • 42950

    Pharyngoplasty, reconstruction of the pharynx8.06 wRVU

    Not priced

How to choose

42820Tonsil and adenoid removalPatient younger than 12
42820 describes a listed combined tonsil and adenoid removal for a patient younger than 12. Use 42999 only when the actual operation lacks a specific listed code.
42821Tonsil and adenoid removalAge 12 or older
42821 describes a listed combined tonsil and adenoid removal for a patient age 12 or older. It is more specific than 42999 when that operation was performed.
42900Pharyngeal repairWound closure
42900 is for a defined repair of a throat wound. 42999 is for a different pharyngeal, adenoid, or tonsillar procedure without a specific code.
42950PharyngoplastyReconstruction of the pharynx
42950 describes a listed throat reconstruction. Choose 42999 only when the procedure performed is not represented by that or another specific code.

Codes related to 42999

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

Codes related to 42999
CodeHow it relatesNational office range
Used instead
42820Tonsil and adenoid removal, patient younger than 12Listed option for combined tonsil and adenoid removal in a patient younger than 12 when it describes the operation.No office rate
42821Tonsil and adenoid removal, age 12 or olderListed option for combined tonsil and adenoid removal in a patient age 12 or older when it describes the operation.No office rate
42825Tonsillectomy, younger than age 12Listed tonsil-removal option for a patient younger than 12 when it describes the operation.No office rate
42826Tonsillectomy, age 12 or olderListed tonsil-removal option for a patient age 12 or older when it describes the operation.No office rate
42830Adenoid removal, primary, younger than 12Listed adenoid-removal option for a patient younger than 12 when it describes the operation.No office rate
42831Adenoidectomy, primary, age 12 or olderListed adenoid-removal option for a patient age 12 or older when it describes the operation.No office rate

42999 billing questions

When should I report 42999 instead of a tonsil or adenoid code?

Use 42999 only when the operation on the pharynx, adenoids, or tonsils is not described by a more specific CPT code. Use the listed code when it accurately describes the procedure performed.

What documentation should accompany a 42999 claim?

Include an operative report describing the procedure, the anatomy treated, and the work performed. Explain why a listed CPT code does not adequately describe it.

How does Medicare determine payment for 42999?

Status C means the Medicare Administrative Contractor sets payment for each claim; CMS publishes no national payment amount for this code.

Who sets the global period for 42999?

The Medicare contractor sets the global period for this unlisted procedure.

How is 42999 treated with other procedures in the same session?

The highest-valued procedure is paid in full, and other procedures are reduced to 50%.

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

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