No office rate
Both describe secondary adenoid removal; use 42835 for patients under 12 and 42836 for patients 12 or older.
On this page
CMS RVU26D · Effective 2026-10-01
42836 Adenoid removal Medicare reimbursement rates in Indiana
Repeat adenoid removal in patients age 12 or older is reported when residual or recurrent adenoid tissue is surgically removed after an earlier adenoidectomy. Compare 42836 office and facility rates across CMS payment localities in Indiana.
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 42836 in Indiana?
Indiana 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
$207.50
1 of 1 localities have a supported rate.
Payment area: Indiana
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 42836: Secondary adenoid removal, age 12 or older
Repeat adenoid removal in patients age 12 or older is reported when residual or recurrent adenoid tissue is surgically removed after an earlier adenoidectomy.
An otolaryngologist removes residual or recurrent adenoid tissue in a patient age 12 or older who has had a prior adenoidectomy. The repeat operation may be considered when remaining or regrown tissue contributes to nasal obstruction, sleep-disordered breathing, or other symptoms. It is generally performed in an operating-room setting. The operative report should establish that this is a secondary procedure and describe the tissue removed and the reason for repeat surgery.
Report this code for secondary adenoid removal in a patient age 12 or older; a primary procedure or a patient under 12 falls into a different code. The service has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42836
- 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 RVU3.18 · 48%
- Practice expense (office) RVU3.03 · 45%
- Malpractice RVU0.46 · 7%
16
Medicare services in 2024 · #6037 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.
42836 compared with similar codes
Office rates for Indiana, from the same CMS release.
No office rate
Both apply to patients age 12 or older. Use 42831 for primary adenoid surgery and 42836 when the patient has had prior adenoid surgery.
No office rate
42821 represents removal of both tonsils and adenoids in a patient age 12 or older. Use 42836 when the repeat procedure is limited to adenoid tissue.
Compare 42836 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
Indiana →
Office / nonfacility
Unavailable
Facility
$207.50
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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 42836 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
5,086
- Code
- 42836
- Physician work
- 3.18
- Practice expense
- 3.03
- Malpractice
- 0.46
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.18 | × 1.000 | 3.1800 |
| Practice expense | 3.03 | × 0.927 | 2.8088 |
| Malpractice | 0.46 | × 0.486 | 0.2236 |
| Total RVUs | 6.2124 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Indiana$207.50
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.18 | 1 |
| Practice expense | 3.03 | 0.927 |
| Malpractice | 0.46 | 0.486 |
(3.18 × 1 + 3.03 × 0.927 + 0.46 × 0.486) × $33.4009 = $207.50
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.
42836 billing questions
How does this differ from 42831?
42836 is for secondary adenoid removal in a patient age 12 or older after prior adenoid surgery. 42831 is for a primary procedure in that age group.
When should 42835 be used instead?
Use 42835 for secondary adenoid removal in a patient under age 12. Age distinguishes it from 42836.
Can this be reported with tonsil removal?
If tonsils and adenoids are both removed in a patient age 12 or older, consider the combined procedure code 42821 rather than separately reporting adenoid removal and tonsillectomy.
What documentation supports secondary removal?
Document the prior adenoidectomy, the current residual or recurrent tissue, the clinical reason for repeat surgery, and the tissue addressed in the operative report.
Can modifier 50 be appended?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
When is an assistant-at-surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity. Co-surgeon and team-surgery payment is not permitted.
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.
5,08342830,,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
5,08942845,,Extensive surgery of throat,A,,31.75,21.39,NA,21.39,,4.64,57.78,57.78,0,090,0.09,0.81,0.10,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915