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 Adenoid removal Medicare reimbursement rates in Connecticut
Reports repeat removal of adenoid tissue in a patient younger than 12 when residual or regrown tissue requires surgical treatment. Compare 42835 office and facility rates across CMS payment localities in Connecticut.
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.
What does Medicare pay for 42835 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$194.63
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
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 Connecticut, 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.
Compare 42835 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
Unavailable
Facility
$194.63
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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 Connecticut.
PPRRVU2026_Oct_nonQPP.csv
5,085
- Code
- 42835
- Physician work
- 2.32
- Practice expense
- 2.82
- Malpractice
- 0.35
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.32 | × 1.020 | 2.3664 |
| Practice expense | 2.82 | × 1.077 | 3.0371 |
| Malpractice | 0.35 | × 1.210 | 0.4235 |
| Total RVUs | 5.8270 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$194.63
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.32 | 1.02 |
| Practice expense | 2.82 | 1.077 |
| Malpractice | 0.35 | 1.21 |
(2.32 × 1.02 + 2.82 × 1.077 + 0.35 × 1.21) × $33.4009 = $194.63
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.
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
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808