FeeBase
Log inGet started
Menu

Billing code 42831: AdenoidectomyMedicare rate & RVUs

Reports primary removal of adenoid tissue in a patient age 12 or older, commonly for obstructive symptoms or recurrent adenoid-related disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities197 Medicare services in 2024

Medicare pays $212.76 for 42831 nationally in a facility.

Medicare rate · 42831

Adenoidectomy

Work RVUs
2.74
Total RVUs
6.37
Global days
090

National rate · 2026

$212.76

Facility setting, before claim adjustments.

See every locality for 42831 →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 42831 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 42831 covers

An otolaryngologist removes adenoid tissue located behind the nasal cavity, commonly to address nasal blockage, sleep-disordered breathing, or recurrent adenoid-related inflammation. The procedure is generally performed in a surgical facility under anesthesia. This code identifies a primary adenoidectomy in a patient who is at least 12 years old; it is not the code for repeat removal of residual or regrown tissue.

Choose the code based on the patient’s age and whether the adenoidectomy is primary or secondary. The operative report should support removal of adenoid tissue and the procedure’s primary status. CMS treats the service as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. 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 42831 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

42831 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$193.48
Alaska*Unavailable$259.54
ArizonaUnavailable$207.50
ArkansasUnavailable$191.07
AtlantaUnavailable$217.45
AustinUnavailable$217.68
BakersfieldUnavailable$219.64
Baltimore/Surr. CntysUnavailable$225.27
BeaumontUnavailable$202.11
BrazoriaUnavailable$209.59

42831 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
42831 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 42831 rate is calculated

Each of 42831’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 · 42831

RVUs × geographic indexes × conversion factor

Work2.74

2.74 RVUs× 1.000 GPCI

Practice expense3.23

3.23 RVUs× 1.000 GPCI

Malpractice0.40

0.40 RVUs× 1.000 GPCI

Adjusted RVUs

6.3700

Conversion factor

$33.4009

Medicare rate

$212.76

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

Payment rules and modifiers for 42831

42831 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42831

Adenoidectomy

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 · 42831

Adenoidectomy

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

42831 without 51 · national facility

$212.76

Adenoidectomy

42831-51 · Second procedure: 50%

$106.38

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

42831 compared with similar codes

Compare codes · National

4 codes, side by side

  • 42831

    Adenoidectomy2.74 wRVU

    Not priced

  • 42830

    Adenoid removal2.58 wRVU

    Not priced

  • 42836

    Adenoid removal3.18 wRVU

    Not priced

  • 42821

    Tonsil and adenoid removal4.25 wRVU

    Not priced

How to choose

42830Adenoid removal
Both are primary adenoidectomies; 42831 is for patients age 12 or older, while 42830 is for patients younger than 12.
42836Adenoid removal
42836 is for secondary adenoidectomy in a patient age 12 or older, such as repeat removal; 42831 is for primary removal.
42821Tonsil and adenoid removal
Use 42821 when both tonsils and adenoids are removed in a patient age 12 or older; 42831 describes primary adenoid removal alone.

Codes related to 42831

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

Codes related to 42831
CodeHow it relatesNational office range
Same family
42830Adenoid removalPrimary adenoidectomy for a patient younger than 12.No office rate
42836Adenoid removalSecondary adenoidectomy for a patient age 12 or older.No office rate
Used instead
42821Tonsil and adenoid removalCombined tonsil and adenoid removal for a patient age 12 or older.No office rate
42820Tonsil and adenoid removalCombined tonsil and adenoid removal for a patient younger than 12.No office rate

42831 billing questions

How does 42831 differ from 42830?

Both describe primary adenoidectomy. Use 42831 for a patient age 12 or older and 42830 for a patient younger than 12.

When is 42836 used instead?

42836 describes secondary adenoidectomy for a patient age 12 or older, such as a repeat procedure for residual or regrown adenoid tissue. Code 42831 is for primary removal.

Should 42831 be reported with a tonsillectomy code when both are removed?

When the surgeon removes both the adenoids and tonsils, compare the age-appropriate combined adenotonsillectomy code, 42821 for age 12 or older, rather than treating the services as adenoidectomy alone.

Can modifier 50 be appended for adenoid removal?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.

What documentation supports reporting 42831?

The operative report should document primary removal of adenoid tissue, and the record should establish that the patient was at least 12 years old on the service date.

When is assistant-at-surgery payment allowed?

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

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 42831PPRRVU2026_Oct_nonQPP.csv, line 5,084 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 42831 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 42831 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 →