No office rate
Use 42821 for combined tonsil and adenoid removal when the patient is age 12 or older; 42820 is for patients younger than 12.
On this page
CMS RVU26D · Effective 2026-10-01
42820 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$264.02
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Otolaryngology surgery
About 42820: Tonsillectomy and adenoidectomy under age 12
Reports removal of both palatine tonsils and adenoid tissue in one operation for a patient younger than 12, including infection or airway obstruction cases.
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.
CMS billing rules for 42820
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.11 · 53%
- Practice expense (office) RVU3.11 · 40%
- Malpractice RVU0.59 · 8%
13
Medicare services in 2024 · #6126 by national volume
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.
42820 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
42825 describes tonsillectomy alone in a patient younger than 12. Choose 42820 when adenoid tissue is also removed in the same session.
No office rate
42830 describes adenoidectomy alone in a patient younger than 12. Choose 42820 when the tonsils are removed during that operation as well.
The same code, a different location
How does Modesto compare?
42820 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Merced
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Napa
California · 42820
Office
Unavailable
Facility
$292.85
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42820
Office
Unavailable
Facility
$276.18
No comparable office rate is available.
Redding
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Rest Of California
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42820
Office
Unavailable
Facility
$270.41
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42820
Office
Unavailable
Facility
$273.59
No comparable office rate is available.
Salinas
California · 42820
Office
Unavailable
Facility
$272.49
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42820
Office
Unavailable
Facility
$276.31
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42820
Office
Unavailable
Facility
$305.83
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42820
Office
Unavailable
Facility
$305.16
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42820
Office
Unavailable
Facility
$312.73
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42820
Office
Unavailable
Facility
$309.99
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42820
Office
Unavailable
Facility
$268.49
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42820
Office
Unavailable
Facility
$276.93
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42820
Office
Unavailable
Facility
$272.80
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42820
Office
Unavailable
Facility
$279.52
No comparable office rate is available.
Stockton
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Vallejo
California · 42820
Office
Unavailable
Facility
$291.88
No comparable office rate is available.
Visalia
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Yuba City
California · 42820
Office
Unavailable
Facility
$264.02
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 42820
Office
Unavailable
Facility
$288.99
No comparable office rate is available.
Miami
Florida · 42820
Office
Unavailable
Facility
$295.25
No comparable office rate is available.
Chicago
Illinois · 42820
Office
Unavailable
Facility
$287.86
No comparable office rate is available.
Manhattan
New York · 42820
Office
Unavailable
Facility
$298.02
No comparable office rate is available.
Alaska*
Alaska · 42820
Office
Unavailable
Facility
$327.40
No comparable office rate is available.
Alabama
Alabama · 42820
Office
Unavailable
Facility
$239.32
No comparable office rate is available.
Arkansas
Arkansas · 42820
Office
Unavailable
Facility
$236.66
No comparable office rate is available.
Arizona
Arizona · 42820
Office
Unavailable
Facility
$254.80
No comparable office rate is available.
Colorado
Colorado · 42820
Office
Unavailable
Facility
$264.84
No comparable office rate is available.
Connecticut
Connecticut · 42820
Office
Unavailable
Facility
$275.74
No comparable office rate is available.
Delaware
Delaware · 42820
Office
Unavailable
Facility
$258.31
No comparable office rate is available.
Fort Lauderdale
Florida · 42820
Office
Unavailable
Facility
$278.13
No comparable office rate is available.
Rest Of Florida
Florida · 42820
Office
Unavailable
Facility
$266.20
No comparable office rate is available.
Atlanta
Georgia · 42820
Office
Unavailable
Facility
$266.90
No comparable office rate is available.
Rest Of Georgia
Georgia · 42820
Office
Unavailable
Facility
$253.43
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42820
Office
Unavailable
Facility
$266.80
No comparable office rate is available.
Iowa
Iowa · 42820
Office
Unavailable
Facility
$240.15
No comparable office rate is available.
Idaho
Idaho · 42820
Office
Unavailable
Facility
$242.17
No comparable office rate is available.
East St. Louis
Illinois · 42820
Office
Unavailable
Facility
$272.53
No comparable office rate is available.
Rest Of Illinois
Illinois · 42820
Office
Unavailable
Facility
$262.92
No comparable office rate is available.
Suburban Chicago
Illinois · 42820
Office
Unavailable
Facility
$279.84
No comparable office rate is available.
Indiana
Indiana · 42820
Office
Unavailable
Facility
$243.15
No comparable office rate is available.
Kansas
Kansas · 42820
Office
Unavailable
Facility
$241.11
No comparable office rate is available.
Kentucky
Kentucky · 42820
Office
Unavailable
Facility
$247.66
No comparable office rate is available.
New Orleans
Louisiana · 42820
Office
Unavailable
Facility
$257.41
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42820
Office
Unavailable
Facility
$248.09
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42820
Office
Unavailable
Facility
$284.47
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42820
Office
Unavailable
Facility
$264.56
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42820
Office
Unavailable
Facility
$275.31
No comparable office rate is available.
Rest Of Maryland
Maryland · 42820
Office
Unavailable
Facility
$261.86
No comparable office rate is available.
Rest Of Maine
Maine · 42820
Office
Unavailable
Facility
$245.10
No comparable office rate is available.
Southern Maine
Maine · 42820
Office
Unavailable
Facility
$252.65
No comparable office rate is available.
Detroit
Michigan · 42820
Office
Unavailable
Facility
$270.74
No comparable office rate is available.
Rest Of Michigan
Michigan · 42820
Office
Unavailable
Facility
$254.37
No comparable office rate is available.
Minnesota
Minnesota · 42820
Office
Unavailable
Facility
$250.00
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42820
Office
Unavailable
Facility
$254.07
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42820
Office
Unavailable
Facility
$255.91
No comparable office rate is available.
Rest Of Missouri
Missouri · 42820
Office
Unavailable
Facility
$246.01
No comparable office rate is available.
Mississippi
Mississippi · 42820
Office
Unavailable
Facility
$241.28
No comparable office rate is available.
Montana**
Montana · 42820
Office
Unavailable
Facility
$260.82
No comparable office rate is available.
North Carolina
North Carolina · 42820
Office
Unavailable
Facility
$246.79
No comparable office rate is available.
North Dakota**
North Dakota · 42820
Office
Unavailable
Facility
$249.16
No comparable office rate is available.
Nebraska
Nebraska · 42820
Office
Unavailable
Facility
$240.61
No comparable office rate is available.
New Hampshire
New Hampshire · 42820
Office
Unavailable
Facility
$262.66
No comparable office rate is available.
Northern Nj
New Jersey · 42820
Office
Unavailable
Facility
$287.47
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42820
Office
Unavailable
Facility
$277.82
No comparable office rate is available.
New Mexico
New Mexico · 42820
Office
Unavailable
Facility
$256.20
No comparable office rate is available.
Nevada**
Nevada · 42820
Office
Unavailable
Facility
$257.67
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42820
Office
Unavailable
Facility
$306.17
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42820
Office
Unavailable
Facility
$281.05
No comparable office rate is available.
Queens
New York · 42820
Office
Unavailable
Facility
$297.26
No comparable office rate is available.
Rest Of New York
New York · 42820
Office
Unavailable
Facility
$249.81
No comparable office rate is available.
Ohio
Ohio · 42820
Office
Unavailable
Facility
$251.98
No comparable office rate is available.
Oklahoma
Oklahoma · 42820
Office
Unavailable
Facility
$245.35
No comparable office rate is available.
Portland
Oregon · 42820
Office
Unavailable
Facility
$269.54
No comparable office rate is available.
Rest Of Oregon
Oregon · 42820
Office
Unavailable
Facility
$254.59
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42820
Office
Unavailable
Facility
$271.39
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42820
Office
Unavailable
Facility
$251.26
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42820
Office
Unavailable
Facility
$261.71
No comparable office rate is available.
Rhode Island
Rhode Island · 42820
Office
Unavailable
Facility
$264.77
No comparable office rate is available.
South Carolina
South Carolina · 42820
Office
Unavailable
Facility
$250.01
No comparable office rate is available.
South Dakota**
South Dakota · 42820
Office
Unavailable
Facility
$247.78
No comparable office rate is available.
Tennessee
Tennessee · 42820
Office
Unavailable
Facility
$242.28
No comparable office rate is available.
Austin
Texas · 42820
Office
Unavailable
Facility
$264.91
No comparable office rate is available.
Beaumont
Texas · 42820
Office
Unavailable
Facility
$250.11
No comparable office rate is available.
Brazoria
Texas · 42820
Office
Unavailable
Facility
$256.69
No comparable office rate is available.
Dallas
Texas · 42820
Office
Unavailable
Facility
$258.88
No comparable office rate is available.
Fort Worth
Texas · 42820
Office
Unavailable
Facility
$258.10
No comparable office rate is available.
Galveston
Texas · 42820
Office
Unavailable
Facility
$257.84
No comparable office rate is available.
Houston
Texas · 42820
Office
Unavailable
Facility
$268.64
No comparable office rate is available.
Rest Of Texas
Texas · 42820
Office
Unavailable
Facility
$253.65
No comparable office rate is available.
Utah
Utah · 42820
Office
Unavailable
Facility
$252.62
No comparable office rate is available.
Virginia
Virginia · 42820
Office
Unavailable
Facility
$253.30
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42820
Office
Unavailable
Facility
$261.71
No comparable office rate is available.
Vermont
Vermont · 42820
Office
Unavailable
Facility
$250.09
No comparable office rate is available.
Rest Of Washington
Washington · 42820
Office
Unavailable
Facility
$263.44
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42820
Office
Unavailable
Facility
$287.70
No comparable office rate is available.
Wisconsin
Wisconsin · 42820
Office
Unavailable
Facility
$242.86
No comparable office rate is available.
West Virginia
West Virginia · 42820
Office
Unavailable
Facility
$255.75
No comparable office rate is available.
Wyoming**
Wyoming · 42820
Office
Unavailable
Facility
$255.74
No comparable office rate is available.
See how rates vary across the country
42820 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 42820 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$290.42
$264.02 × 110% = $290.42
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 42820 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
5,079
- Code
- 42820
- Physician work
- 4.11
- Practice expense
- 3.11
- Malpractice
- 0.59
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.11 | × 1.017 | 4.1799 |
| Practice expense | 3.11 | × 1.096 | 3.4086 |
| Malpractice | 0.59 | × 0.536 | 0.3162 |
| Total RVUs | 7.9047 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$264.02
Open 42820 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.11 | 1.017 |
| Practice expense | 3.11 | 1.096 |
| Malpractice | 0.59 | 0.536 |
(4.11 × 1.017 + 3.11 × 1.096 + 0.59 × 0.536) × $33.4009 = $264.02
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
42820 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $264.02 | RVU26D |
| 2026-07-01 | Not available in this setting | $264.02 | RVU26C |
| 2026-04-01 | Not available in this setting | $264.02 | RVU26B |
| 2026-01-01 | Not available in this setting | $264.02 | RVU26A |
| 2025-10-01 | Not available in this setting | $293.00 | RVU25D |
| 2025-07-01 | Not available in this setting | $293.00 | RVU25C |
| 2025-04-01 | Not available in this setting | $293.00 | RVU25B |
| 2025-01-01 | Not available in this setting | $293.00 | RVU25A |
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
5,0764280F,,Pcp prophylax rxd 3mon low %,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07742810,,Excision of neck cyst,A,,3.30,7.79,,3.95,,0.47,11.56,7.72,0,090,0.09,0.81,0.10,2,1,2,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07842815,,Excision of neck cyst,A,,7.13,6.14,NA,6.14,,1.05,14.32,14.32,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07942820,,Remove tonsils and adenoids,A,,4.11,3.11,NA,3.11,,0.59,7.81,7.81,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08042821,,Remove tonsils and adenoids,A,,4.25,3.29,NA,3.29,,0.61,8.15,8.15,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08142825,,Removal of tonsils,A,,3.42,3.39,NA,3.39,,0.48,7.29,7.29,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08242826,,Removal of tonsils,A,,3.36,3.09,NA,3.09,,0.48,6.93,6.93,0,090,0.09,0.81,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536