Billing code 42835: Adenoid removalMedicare rate & RVUs in Florida
Reports repeat removal of adenoid tissue in a patient younger than 12 when residual or regrown tissue requires surgical treatment.
CMS doesn’t publish an office rate for 42835 in Florida.
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 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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $194.04 |
| Miami | Unavailable | $205.11 |
| Rest Of Florida | Unavailable | $185.11 |
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
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
| 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 · 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.
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%).
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.
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.
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
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