FeeBase
Log inGet started
Menu

Billing code 42820: Tonsil and adenoid removalMedicare rate & RVUs

Reports removal of both palatine tonsils and adenoid tissue in one operation for a patient younger than 12, including infection or airway obstruction cases.

CMS RVU26DEffective Oct 1, 2026109 payment localities13 Medicare services in 2024

Medicare pays $260.86 for 42820 nationally in a facility.

Medicare rate · 42820

Tonsil and adenoid removal

Swap in your local Medicare rate.

Work RVUs
4.11
Total RVUs
7.81
Global days
090

National rate · 2026

$260.86

Facility setting, before claim adjustments.

See every locality for 42820 → · 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
  1. Medicare rate
  2. What 42820 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 42820 covers

The operation removes the palatine tonsils and adenoid tissue during the same session. Otolaryngologists commonly perform it for recurrent tonsillitis or sleep-disordered breathing associated with enlarged adenotonsillar tissue. The procedure is generally performed in a hospital or ambulatory surgery center, often under general anesthesia.

Select this code when the patient is younger than 12 on the date of surgery and both tonsils and adenoids are removed. The operative report should identify both tissues removed, the clinical indication, and the service date. Tonsillectomy alone or adenoidectomy alone is reported with the code for that procedure instead. This major surgery has a 90-day global period that includes the day-before preoperative visit and related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Report the combined operation once; modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity. CMS does not recognize co-surgeon or team-surgery billing for this code.

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 42820 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

42820 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$239.32
Alaska*Unavailable$327.40
ArizonaUnavailable$254.80
ArkansasUnavailable$236.66
AtlantaUnavailable$266.90
AustinUnavailable$264.91
BakersfieldUnavailable$265.74
Baltimore/Surr. CntysUnavailable$275.31
BeaumontUnavailable$250.11
BrazoriaUnavailable$256.69

42820 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
42820 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 42820 rate is calculated

Each of 42820’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 · 42820

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 4.11Practice expense 3.11Malpractice 0.59

7.8100 adjusted RVUs×$33.4009 conversion factor=$260.86

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 42820

42820 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42820

Tonsil and adenoid removal

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 · 42820

Tonsil and adenoid removal

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

42820 without 51 · national facility

$260.86

Tonsil and adenoid removal

42820-51 · Second procedure: 50%

$130.43

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

42820 compared with similar codes

Compare codes

42820 vs 42821 vs 42825 vs 42830: national Medicare rates

Swap in your local Medicare rate.

  • 42820
    Tonsil and adenoid removal · 4.11 wRVU
    —
  • 42821
    Tonsil and adenoid removal · 4.25 wRVU
    —
  • 42825
    Tonsillectomy · 3.42 wRVU
    —
  • 42830
    Adenoid removal · 2.58 wRVU
    —

How to choose

42821Tonsil and adenoid removal
Use 42821 for combined tonsil and adenoid removal when the patient is age 12 or older; 42820 is for patients younger than 12.
42825Tonsillectomy
42825 describes tonsillectomy alone in a patient younger than 12. Choose 42820 when adenoid tissue is also removed in the same session.
42830Adenoid removal
42830 describes adenoidectomy alone in a patient younger than 12. Choose 42820 when the tonsils are removed during that operation as well.

Codes related to 42820

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

Codes related to 42820
CodeHow it relatesNational office range
Same family
42821Tonsil and adenoid removalCombined tonsil and adenoid removal for a patient age 12 or older.No office rate
Used instead
42825TonsillectomyTonsillectomy alone for a patient younger than 12 when adenoid tissue is not removed.No office rate
42830Adenoid removalAdenoidectomy alone for a patient younger than 12 when tonsils are not removed.No office rate

42820 billing questions

How does 42820 differ from 42821?

Both describe removal of the tonsils and adenoids in one session. Use 42820 for a patient younger than 12 on the surgery date and 42821 for a patient age 12 or older.

Can the tonsillectomy and adenoidectomy also be billed separately?

When both are removed in the same session, report the combined code rather than separately reporting the tonsillectomy and adenoidectomy codes for that same work.

What documentation supports reporting 42820?

The operative report should show that both the palatine tonsils and adenoid tissue were removed, and establish the patient's age on the procedure date.

Should modifier 50 be appended?

No. Report the combined operation once; modifier 50 is inappropriate for this code.

When is assistant-at-surgery payment available?

CMS allows assistant-at-surgery payment only when the record documents medical necessity.

How does the global period affect postoperative care?

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

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 42820PPRRVU2026_Oct_nonQPP.csv, line 5,079 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 42820 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 42820 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →