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Billing code 42835: Adenoid removalMedicare rate & RVUs

Reports repeat removal of adenoid tissue in a patient younger than 12 when residual or regrown tissue requires surgical treatment.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $183.37 for 42835 nationally in a facility.

Medicare rate · 42835

Adenoid removal

Swap in your local Medicare rate.

Work RVUs
2.32
Total RVUs
5.49
Global days
090

National rate · 2026

$183.37

Facility setting, before claim adjustments.

See every locality for 42835 → · 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 42835 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 42835 covers

An otolaryngologist performs this repeat operation when adenoid tissue remains or regrows after an earlier adenoidectomy and is causing a clinical problem, such as nasal obstruction or sleep-disordered breathing. The procedure is generally performed in an operating room under anesthesia. The age qualifier is younger than 12; the secondary designation distinguishes it from an initial adenoid operation.

The operative report should establish the patient’s age, prior adenoid surgery, the recurrent or residual tissue addressed, and the work performed. 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% reduction. A bilateral adjustment is inappropriate for this service. 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 42835 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

42835 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$166.52
Alaska*Unavailable$222.99
ArizonaUnavailable$178.77
ArkansasUnavailable$164.42
AtlantaUnavailable$187.46
AustinUnavailable$187.66
BakersfieldUnavailable$189.31
Baltimore/Surr. CntysUnavailable$194.26
BeaumontUnavailable$174.06
BrazoriaUnavailable$180.57

42835 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
42835 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 42835 rate is calculated

Each of 42835’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 · 42835

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 2.32Practice expense 2.82Malpractice 0.35

5.4900 adjusted RVUs×$33.4009 conversion factor=$183.37

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

Payment rules and modifiers for 42835

42835 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 42835

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 · 42835

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

42835 without 51 · national facility

$183.37

Adenoid removal

42835-51 · Second procedure: 50%

$91.69

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

42835 compared with similar codes

Compare codes

42835 vs 42830 vs 42836 vs 42820 vs 42825: national Medicare rates

Swap in your local Medicare rate.

  • 42835
    Adenoid removal · 2.32 wRVU
    —
  • 42830
    Adenoid removal · 2.58 wRVU
    —
  • 42836
    Adenoid removal · 3.18 wRVU
    —
  • 42820
    Tonsil and adenoid removal · 4.11 wRVU
    —
  • 42825
    Tonsillectomy · 3.42 wRVU
    —

How to choose

42830Adenoid removal
42830 is a primary adenoidectomy for a patient younger than 12. Use 42835 when the adenoid operation is secondary.
42836Adenoid removal
Both codes describe secondary adenoid removal; choose 42835 for a patient younger than 12 and 42836 for a patient age 12 or older.
42820Tonsil and adenoid removal
42820 includes removal of both tonsils and adenoids in a patient younger than 12. Code 42835 describes secondary adenoid removal, not the combined operation.
42825Tonsillectomy
42825 describes tonsil removal alone in a patient younger than 12; it does not include repeat adenoid removal.

Codes related to 42835

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

Codes related to 42835
CodeHow it relatesNational office range
Same family
42830Adenoid removalPrimary adenoid removal for a patient younger than 12.No office rate
42831AdenoidectomyPrimary adenoid removal for a patient age 12 or older.No office rate
42836Adenoid removalSecondary adenoid removal for a patient age 12 or older.No office rate
Used instead
42820Tonsil and adenoid removalCombined tonsil and adenoid removal for a patient younger than 12.No office rate
42821Tonsil and adenoid removalCombined tonsil and adenoid removal for a patient age 12 or older.No office rate
42825TonsillectomyTonsil removal alone for a patient younger than 12.No office rate
42826TonsillectomyTonsil removal alone for a patient age 12 or older.No office rate

42835 billing questions

When is 42835 used instead of 42830?

Use 42835 for repeat adenoid removal in a patient younger than 12. Code 42830 describes a primary adenoidectomy in that age group.

How does age affect selection between 42835 and 42836?

Both describe secondary adenoid removal; 42835 is for patients younger than 12, while 42836 is for patients age 12 or older.

Can this be reported with a tonsillectomy?

The operative record should show whether the tonsils were also removed and which services were performed. The combined tonsil-and-adenoid codes 42820 and 42821 describe removal of both tissues, rather than adenoid removal alone.

What documentation supports the secondary designation?

Document the prior adenoidectomy, the residual or regrown tissue found, the reason it required repeat treatment, and the operative work performed.

Does modifier 50 apply, and what about an assistant?

Modifier 50 is inappropriate for this adenoid procedure. Assistant-at-surgery payment requires documentation of medical necessity.

What care is included in the global period?

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 42835PPRRVU2026_Oct_nonQPP.csv, line 5,085 (RVU26D)

Open CMS sourceHow we calculate rates

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