No office rate
42830 is a primary adenoidectomy for a patient younger than 12. Use 42835 when the adenoid operation is secondary.
On this page
CMS RVU26D · Effective 2026-10-01
42835 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$188.31
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 42835: Secondary adenoidectomy under age 12
Reports repeat removal of adenoid tissue in a patient younger than 12 when residual or regrown tissue requires surgical treatment.
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.
CMS billing rules for 42835
- 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 RVU2.32 · 42%
- Practice expense (office) RVU2.82 · 51%
- Malpractice RVU0.35 · 6%
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.
42835 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
Both codes describe secondary adenoid removal; choose 42835 for a patient younger than 12 and 42836 for a patient age 12 or older.
No office rate
42820 includes removal of both tonsils and adenoids in a patient younger than 12. Code 42835 describes secondary adenoid removal, not the combined operation.
No office rate
42825 describes tonsil removal alone in a patient younger than 12; it does not include repeat adenoid removal.
The same code, a different location
How does Modesto compare?
42835 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 · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Merced
California · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Napa
California · 42835
Office
Unavailable
Facility
$212.45
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 42835
Office
Unavailable
Facility
$198.28
No comparable office rate is available.
Redding
California · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Rest Of California
California · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 42835
Office
Unavailable
Facility
$192.09
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 42835
Office
Unavailable
Facility
$196.09
No comparable office rate is available.
Salinas
California · 42835
Office
Unavailable
Facility
$195.33
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 42835
Office
Unavailable
Facility
$198.80
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 42835
Office
Unavailable
Facility
$223.03
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 42835
Office
Unavailable
Facility
$222.63
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 42835
Office
Unavailable
Facility
$228.10
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 42835
Office
Unavailable
Facility
$226.48
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 42835
Office
Unavailable
Facility
$192.36
No comparable office rate is available.
Santa Cruz-Watsonville
California · 42835
Office
Unavailable
Facility
$199.82
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 42835
Office
Unavailable
Facility
$195.75
No comparable office rate is available.
Santa Rosa-Petaluma
California · 42835
Office
Unavailable
Facility
$201.75
No comparable office rate is available.
Stockton
California · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Vallejo
California · 42835
Office
Unavailable
Facility
$211.88
No comparable office rate is available.
Visalia
California · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Yuba City
California · 42835
Office
Unavailable
Facility
$188.31
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 42835
Office
Unavailable
Facility
$205.64
No comparable office rate is available.
Miami
Florida · 42835
Office
Unavailable
Facility
$205.11
No comparable office rate is available.
Chicago
Illinois · 42835
Office
Unavailable
Facility
$199.52
No comparable office rate is available.
Manhattan
New York · 42835
Office
Unavailable
Facility
$210.44
No comparable office rate is available.
Alaska*
Alaska · 42835
Office
Unavailable
Facility
$222.99
No comparable office rate is available.
Alabama
Alabama · 42835
Office
Unavailable
Facility
$166.52
No comparable office rate is available.
Arkansas
Arkansas · 42835
Office
Unavailable
Facility
$164.42
No comparable office rate is available.
Arizona
Arizona · 42835
Office
Unavailable
Facility
$178.77
No comparable office rate is available.
Colorado
Colorado · 42835
Office
Unavailable
Facility
$187.77
No comparable office rate is available.
Connecticut
Connecticut · 42835
Office
Unavailable
Facility
$194.63
No comparable office rate is available.
Delaware
Delaware · 42835
Office
Unavailable
Facility
$181.45
No comparable office rate is available.
Fort Lauderdale
Florida · 42835
Office
Unavailable
Facility
$194.04
No comparable office rate is available.
Rest Of Florida
Florida · 42835
Office
Unavailable
Facility
$185.11
No comparable office rate is available.
Atlanta
Georgia · 42835
Office
Unavailable
Facility
$187.46
No comparable office rate is available.
Rest Of Georgia
Georgia · 42835
Office
Unavailable
Facility
$175.44
No comparable office rate is available.
Hawaii, Guam
Hawaii · 42835
Office
Unavailable
Facility
$191.35
No comparable office rate is available.
Iowa
Iowa · 42835
Office
Unavailable
Facility
$168.32
No comparable office rate is available.
Idaho
Idaho · 42835
Office
Unavailable
Facility
$169.67
No comparable office rate is available.
East St. Louis
Illinois · 42835
Office
Unavailable
Facility
$187.69
No comparable office rate is available.
Rest Of Illinois
Illinois · 42835
Office
Unavailable
Facility
$181.76
No comparable office rate is available.
Suburban Chicago
Illinois · 42835
Office
Unavailable
Facility
$195.48
No comparable office rate is available.
Indiana
Indiana · 42835
Office
Unavailable
Facility
$170.49
No comparable office rate is available.
Kansas
Kansas · 42835
Office
Unavailable
Facility
$168.53
No comparable office rate is available.
Kentucky
Kentucky · 42835
Office
Unavailable
Facility
$171.92
No comparable office rate is available.
New Orleans
Louisiana · 42835
Office
Unavailable
Facility
$179.40
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 42835
Office
Unavailable
Facility
$172.05
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 42835
Office
Unavailable
Facility
$203.54
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 42835
Office
Unavailable
Facility
$187.23
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 42835
Office
Unavailable
Facility
$194.26
No comparable office rate is available.
Rest Of Maryland
Maryland · 42835
Office
Unavailable
Facility
$184.32
No comparable office rate is available.
Rest Of Maine
Maine · 42835
Office
Unavailable
Facility
$171.42
No comparable office rate is available.
Southern Maine
Maine · 42835
Office
Unavailable
Facility
$178.21
No comparable office rate is available.
Detroit
Michigan · 42835
Office
Unavailable
Facility
$188.09
No comparable office rate is available.
Rest Of Michigan
Michigan · 42835
Office
Unavailable
Facility
$176.68
No comparable office rate is available.
Minnesota
Minnesota · 42835
Office
Unavailable
Facility
$177.87
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 42835
Office
Unavailable
Facility
$177.36
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 42835
Office
Unavailable
Facility
$178.87
No comparable office rate is available.
Rest Of Missouri
Missouri · 42835
Office
Unavailable
Facility
$170.07
No comparable office rate is available.
Mississippi
Mississippi · 42835
Office
Unavailable
Facility
$167.23
No comparable office rate is available.
Montana**
Montana · 42835
Office
Unavailable
Facility
$183.35
No comparable office rate is available.
North Carolina
North Carolina · 42835
Office
Unavailable
Facility
$172.84
No comparable office rate is available.
North Dakota**
North Dakota · 42835
Office
Unavailable
Facility
$176.43
No comparable office rate is available.
Nebraska
Nebraska · 42835
Office
Unavailable
Facility
$168.85
No comparable office rate is available.
New Hampshire
New Hampshire · 42835
Office
Unavailable
Facility
$185.77
No comparable office rate is available.
Northern Nj
New Jersey · 42835
Office
Unavailable
Facility
$204.12
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 42835
Office
Unavailable
Facility
$196.27
No comparable office rate is available.
New Mexico
New Mexico · 42835
Office
Unavailable
Facility
$177.90
No comparable office rate is available.
Nevada**
Nevada · 42835
Office
Unavailable
Facility
$181.51
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 42835
Office
Unavailable
Facility
$216.15
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 42835
Office
Unavailable
Facility
$198.26
No comparable office rate is available.
Queens
New York · 42835
Office
Unavailable
Facility
$210.64
No comparable office rate is available.
Rest Of New York
New York · 42835
Office
Unavailable
Facility
$175.19
No comparable office rate is available.
Ohio
Ohio · 42835
Office
Unavailable
Facility
$175.27
No comparable office rate is available.
Oklahoma
Oklahoma · 42835
Office
Unavailable
Facility
$170.69
No comparable office rate is available.
Portland
Oregon · 42835
Office
Unavailable
Facility
$192.07
No comparable office rate is available.
Rest Of Oregon
Oregon · 42835
Office
Unavailable
Facility
$179.52
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 42835
Office
Unavailable
Facility
$190.88
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 42835
Office
Unavailable
Facility
$175.00
No comparable office rate is available.
Puerto Rico
Puerto Rico · 42835
Office
Unavailable
Facility
$184.23
No comparable office rate is available.
Rhode Island
Rhode Island · 42835
Office
Unavailable
Facility
$186.69
No comparable office rate is available.
South Carolina
South Carolina · 42835
Office
Unavailable
Facility
$174.46
No comparable office rate is available.
South Dakota**
South Dakota · 42835
Office
Unavailable
Facility
$175.61
No comparable office rate is available.
Tennessee
Tennessee · 42835
Office
Unavailable
Facility
$169.39
No comparable office rate is available.
Austin
Texas · 42835
Office
Unavailable
Facility
$187.66
No comparable office rate is available.
Beaumont
Texas · 42835
Office
Unavailable
Facility
$174.06
No comparable office rate is available.
Brazoria
Texas · 42835
Office
Unavailable
Facility
$180.57
No comparable office rate is available.
Dallas
Texas · 42835
Office
Unavailable
Facility
$182.03
No comparable office rate is available.
Fort Worth
Texas · 42835
Office
Unavailable
Facility
$181.24
No comparable office rate is available.
Galveston
Texas · 42835
Office
Unavailable
Facility
$181.32
No comparable office rate is available.
Houston
Texas · 42835
Office
Unavailable
Facility
$187.73
No comparable office rate is available.
Rest Of Texas
Texas · 42835
Office
Unavailable
Facility
$177.43
No comparable office rate is available.
Utah
Utah · 42835
Office
Unavailable
Facility
$176.53
No comparable office rate is available.
Virginia
Virginia · 42835
Office
Unavailable
Facility
$178.33
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 42835
Office
Unavailable
Facility
$184.23
No comparable office rate is available.
Vermont
Vermont · 42835
Office
Unavailable
Facility
$176.65
No comparable office rate is available.
Rest Of Washington
Washington · 42835
Office
Unavailable
Facility
$186.58
No comparable office rate is available.
Seattle (King Cnty)
Washington · 42835
Office
Unavailable
Facility
$206.49
No comparable office rate is available.
Wisconsin
Wisconsin · 42835
Office
Unavailable
Facility
$171.33
No comparable office rate is available.
West Virginia
West Virginia · 42835
Office
Unavailable
Facility
$176.07
No comparable office rate is available.
Wyoming**
Wyoming · 42835
Office
Unavailable
Facility
$180.33
No comparable office rate is available.
See how rates vary across the country
42835 · 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 42835 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$207.14
$188.31 × 110% = $207.14
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 42835 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
5,085
- Code
- 42835
- Physician work
- 2.32
- Practice expense
- 2.82
- Malpractice
- 0.35
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.32 | × 1.017 | 2.3594 |
| Practice expense | 2.82 | × 1.096 | 3.0907 |
| Malpractice | 0.35 | × 0.536 | 0.1876 |
| Total RVUs | 5.6378 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$188.31
Open 42835 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.32 | 1.017 |
| Practice expense | 2.82 | 1.096 |
| Malpractice | 0.35 | 0.536 |
(2.32 × 1.017 + 2.82 × 1.096 + 0.35 × 0.536) × $33.4009 = $188.31
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
42835 · 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 | $188.31 | RVU26D |
| 2026-07-01 | Not available in this setting | $188.31 | RVU26C |
| 2026-04-01 | Not available in this setting | $188.31 | RVU26B |
| 2026-01-01 | Not available in this setting | $188.31 | RVU26A |
| 2025-10-01 | Not available in this setting | $203.19 | RVU25D |
| 2025-07-01 | Not available in this setting | $203.19 | RVU25C |
| 2025-04-01 | Not available in this setting | $203.19 | RVU25B |
| 2025-01-01 | Not available in this setting | $203.19 | RVU25A |
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 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.
5,08242826,,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
5,08342830,,Removal of adenoids,A,,2.58,2.89,NA,2.89,,0.38,5.85,5.85,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08442831,,Removal of adenoids,A,,2.74,3.23,NA,3.23,,0.40,6.37,6.37,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08542835,,Removal of adenoids,A,,2.32,2.82,NA,2.82,,0.35,5.49,5.49,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08642836,,Removal of adenoids,A,,3.18,3.03,NA,3.03,,0.46,6.67,6.67,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08742842,,Extensive surgery of throat,A,,11.92,13.58,NA,13.58,,1.77,27.27,27.27,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08842844,,Extensive surgery of throat,A,,17.34,16.83,NA,16.83,,2.61,36.78,36.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,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