Billing code 42700: Abscess drainageMedicare rate & RVUs
Reports incision and drainage of a peritonsillar abscess, distinguishing this tonsil-adjacent collection from other pharyngeal abscesses.
Medicare pays $199.07 for 42700 nationally in the office and $128.26 in a hospital or facility. Local office rates run $175.69–$261.11.
Medicare rate · 42700
Abscess drainage
Swap in your local Medicare rate.
- Work RVUs
- 1.63
- Total RVUs
- 5.96
- Global days
- 010
National rate · 2026
$199.07
Office setting, before claim adjustments.
See every locality for 42700 → · 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.
On this page 10 sections
What 42700 covers
Code 42700 represents incision and drainage of an abscess in the tissue beside a tonsil. An otolaryngologist or other physician may perform the procedure for a peritonsillar abscess in an office, emergency department, or hospital setting. The service is drainage of the abscess rather than removal of the tonsil. Documentation should identify the peritonsillar location and describe the incision-and-drainage work performed.
Select 42700 when the documented abscess is peritonsillar; codes 42720 and 42725 describe drainage of a pharyngeal abscess by intraoral and external approaches, respectively. The service has a 10-day global period, so related postoperative visits during those 10 days are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery for this service, and 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 42700 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$175.69 to $261.11
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $178.31 | $116.35 |
| Alaska* | $231.23 | $155.82 |
| Arizona | $193.60 | $124.99 |
| Arkansas | $175.69 | $114.86 |
| Atlanta | $203.15 | $131.21 |
| Austin | $206.07 | $131.16 |
| Bakersfield | $209.76 | $132.15 |
| Baltimore/Surr. Cntys | $211.92 | $135.94 |
| Beaumont | $186.22 | $121.78 |
| Brazoria | $196.37 | $126.20 |
| Chicago | $211.38 | $140.21 |
| Chico | $209.02 | $131.41 |
| Colorado | $206.52 | $131.18 |
| Connecticut | $212.45 | $136.19 |
| Dallas | $197.78 | $127.26 |
| Dc + Md/Va Suburbs | $227.19 | $143.77 |
| Delaware | $196.83 | $126.87 |
| Detroit | $200.27 | $131.94 |
| East St. Louis | $197.00 | $131.85 |
| El Centro | $209.06 | $131.45 |
| Fort Lauderdale | $207.85 | $136.12 |
| Fort Worth | $196.54 | $126.72 |
| Fresno | $209.02 | $131.41 |
| Galveston | $197.06 | $126.75 |
| Hanford-Corcoran | $209.02 | $131.41 |
| Hawaii, Guam | $214.04 | $133.53 |
| Houston | $201.82 | $131.50 |
| Idaho | $183.62 | $118.47 |
| Indiana | $184.68 | $119.04 |
| Iowa | $182.28 | $117.49 |
| Kansas | $181.71 | $117.70 |
| Kentucky | $183.24 | $120.29 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $223.26 | $139.49 |
| Madera | $209.02 | $131.41 |
| Manhattan | $229.67 | $147.38 |
| Merced | $209.02 | $131.41 |
| Metropolitan Boston | $226.72 | $142.17 |
| Metropolitan Kansas City | $190.58 | $124.09 |
| Metropolitan Philadelphia | $207.30 | $133.59 |
| Metropolitan St. Louis | $192.56 | $125.15 |
| Miami | $217.92 | $144.21 |
| Minnesota | $196.90 | $124.03 |
| Mississippi | $177.91 | $116.94 |
| Modesto | $209.02 | $131.41 |
| Montana** | $199.05 | $128.24 |
| Napa | $241.46 | $148.13 |
| Nebraska | $183.20 | $117.84 |
| Nevada** | $197.76 | $126.87 |
| New Hampshire | $203.56 | $129.84 |
| New Mexico | $189.53 | $124.60 |
| New Orleans | $192.23 | $125.60 |
| North Carolina | $186.83 | $120.76 |
| North Dakota** | $193.91 | $123.10 |
| Northern Nj | $224.84 | $142.70 |
| Nyc Suburbs/Long Island | $235.69 | $151.50 |
| Ohio | $187.31 | $122.66 |
| Oklahoma | $182.59 | $119.35 |
| Oxnard-Thousand Oaks-Ventura | $222.06 | $138.36 |
| Portland | $212.81 | $134.14 |
| Poughkpsie/N Nyc Suburbs | $216.26 | $138.72 |
| Puerto Rico | $200.43 | $128.85 |
| Queens | $231.13 | $147.44 |
| Redding | $209.02 | $131.41 |
| Rest Of California | $209.02 | $131.41 |
| Rest Of Florida | $197.46 | $129.76 |
| Rest Of Georgia | $186.06 | $122.89 |
| Rest Of Illinois | $192.13 | $127.48 |
| Rest Of Louisiana | $183.07 | $120.40 |
| Rest Of Maine | $184.91 | $119.77 |
| Rest Of Maryland | $200.53 | $128.87 |
| Rest Of Massachusetts | $205.38 | $130.82 |
| Rest Of Michigan | $188.36 | $123.71 |
| Rest Of Missouri | $180.08 | $119.05 |
| Rest Of New Jersey | $214.60 | $137.27 |
| Rest Of New York | $189.69 | $122.42 |
| Rest Of Oregon | $195.95 | $125.42 |
| Rest Of Pennsylvania | $187.44 | $122.44 |
| Rest Of Texas | $191.29 | $124.10 |
| Rest Of Washington | $204.91 | $130.34 |
| Rhode Island | $203.65 | $130.51 |
| Riverside-San Bernardino-Ontario | $211.82 | $134.22 |
| Sacramento-Roseville-Folsom | $219.16 | $136.81 |
| Salinas | $218.34 | $136.27 |
| San Diego-Chula Vista-Carlsbad | $223.37 | $138.68 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $255.28 | $155.44 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $254.98 | $155.14 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $261.11 | $159.01 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $259.91 | $157.80 |
| San Luis Obispo-Paso Robles | $214.86 | $134.21 |
| Santa Cruz-Watsonville | $225.41 | $139.38 |
| Santa Maria-Santa Barbara | $219.13 | $136.57 |
| Santa Rosa-Petaluma | $227.67 | $140.71 |
| Seattle (King Cnty) | $231.06 | $144.18 |
| South Carolina | $187.44 | $122.01 |
| South Dakota** | $193.30 | $122.49 |
| Southern Maine | $194.64 | $124.47 |
| Stockton | $209.02 | $131.41 |
| Suburban Chicago | $209.83 | $137.10 |
| Tennessee | $182.68 | $118.31 |
| Utah | $190.03 | $123.47 |
| Vallejo | $241.03 | $147.70 |
| Vermont | $193.42 | $123.32 |
| Virgin Islands | $200.43 | $128.85 |
| Virginia | $194.21 | $124.60 |
| Visalia | $209.02 | $131.41 |
| West Virginia | $185.00 | $123.47 |
| Wisconsin | $187.35 | $119.51 |
| Wyoming** | $196.81 | $126.00 |
| Yuba City | $209.02 | $131.41 |
42700 rates by state
Office rate range in each state. Select a state to see its payment localities.
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.
$175.69
$235.07
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $231.23 | 1 |
| AL | $178.31 | 1 |
| AR | $175.69 | 1 |
| AZ | $193.60 | 1 |
| CA | $209.02–$261.11 | 29 |
| CO | $206.52 | 1 |
| CT | $212.45 | 1 |
| DC | $227.19 | 1 |
| DE | $196.83 | 1 |
| FL | $197.46–$217.92 | 3 |
| GA | $186.06–$203.15 | 2 |
| GU | $214.04 | 1 |
| HI | $214.04 | 1 |
| IA | $182.28 | 1 |
| ID | $183.62 | 1 |
| IL | $192.13–$211.38 | 4 |
| IN | $184.68 | 1 |
| KS | $181.71 | 1 |
| KY | $183.24 | 1 |
| LA | $183.07–$192.23 | 2 |
| MA | $205.38–$226.72 | 2 |
| MD | $200.53–$227.19 | 3 |
| ME | $184.91–$194.64 | 2 |
| MI | $188.36–$200.27 | 2 |
| MN | $196.90 | 1 |
| MO | $180.08–$192.56 | 3 |
| MS | $177.91 | 1 |
| MT | $199.05 | 1 |
| NC | $186.83 | 1 |
| ND | $193.91 | 1 |
| NE | $183.20 | 1 |
| NH | $203.56 | 1 |
| NJ | $214.60–$224.84 | 2 |
| NM | $189.53 | 1 |
| NV | $197.76 | 1 |
| NY | $189.69–$235.69 | 5 |
| OH | $187.31 | 1 |
| OK | $182.59 | 1 |
| OR | $195.95–$212.81 | 2 |
| PA | $187.44–$207.30 | 2 |
| PR | $200.43 | 1 |
| RI | $203.65 | 1 |
| SC | $187.44 | 1 |
| SD | $193.30 | 1 |
| TN | $182.68 | 1 |
| TX | $186.22–$206.07 | 8 |
| UT | $190.03 | 1 |
| VA | $194.21–$227.19 | 2 |
| VI | $200.43 | 1 |
| VT | $193.42 | 1 |
| WA | $204.91–$231.06 | 2 |
| WI | $187.35 | 1 |
| WV | $185.00 | 1 |
| WY | $196.81 | 1 |
How the 42700 rate is calculated
Each of 42700’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 · 42700
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.63Practice expense 4.07Malpractice 0.26
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42700
42700 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42700
Abscess drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 42700
Abscess drainage
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
42700 without 51 · national office
$199.07
Abscess drainage
42700-51 · Second procedure: 50%
$99.54
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%).
42700 compared with similar codes
Compare codes
42700 vs 42720 vs 42725 vs 42826: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42720Pharyngeal abscess drainage
- 42700 is for a peritonsillar abscess. Use 42720 for pharyngeal abscess drainage performed by an intraoral approach.
- 42725Pharyngeal abscess drainage
- 42700 identifies a peritonsillar abscess. Code 42725 describes pharyngeal abscess drainage by an external approach.
- 42826Tonsillectomy
- Use 42700 for incision and drainage of a peritonsillar abscess. Code 42826 is for tonsillectomy in a patient age 12 or older, when the tonsil is removed.
42700 billing questions
When should I report 42700 rather than 42720 or 42725?
Report 42700 for drainage of a peritonsillar abscess. Codes 42720 and 42725 are for pharyngeal abscess drainage by intraoral and external approaches, respectively.
Are related postoperative visits separately payable?
Related postoperative visits during the 10-day global period are included in 42700.
Should I append modifier 50 for bilateral drainage?
No. CMS identifies bilateral adjustment as inapplicable to this code, and modifier 50 is inappropriate.
How does the multiple-procedure reduction affect 42700?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%.
What documentation supports reporting 42700?
Document that the abscess is peritonsillar and describe the incision and drainage performed. The documented location helps distinguish this service from drainage of a pharyngeal abscess.
Can an assistant or co-surgeon be reported for 42700?
Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.
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
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