Billing code 42820: Tonsil and adenoid removalMedicare rate & RVUs in Alaska
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 doesn’t publish an office rate for 42820 in Alaska.
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 9 sections
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.
42820 in Alaska*
| Payment locality | Office | Facility |
|---|---|---|
| Alaska* | Unavailable | $327.40 |
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
Work4.11
4.11 RVUs× 1.000 GPCI
Practice expense3.11
3.11 RVUs× 1.000 GPCI
Malpractice0.59
0.59 RVUs× 1.000 GPCI
Adjusted RVUs
7.8100
Conversion factor
$33.4009
Medicare rate
$260.86
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.09/0.81/0.10 | Share 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.
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%).
42820 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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