No office rate
The procedure is tonsil removal in both codes; age determines the choice. Use 42825 below age 12 and 42826 at age 12 or older.
On this page
CMS RVU26D · Effective 2026-10-01
42825 Tonsillectomy Medicare reimbursement rates in Kansas
Reports surgical removal of the palatine tonsils in a patient younger than 12, commonly for recurrent infection or tonsillar obstruction. Compare 42825 office and facility rates across CMS payment localities in Kansas.
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 42825 in Kansas?
Kansas 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
$224.67
1 of 1 localities have a supported rate.
Payment area: Kansas
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 42825: Tonsil removal, younger than 12
Reports surgical removal of the palatine tonsils in a patient younger than 12, commonly for recurrent infection or tonsillar obstruction.
An otolaryngologist typically performs this operation in an operating room, removing the palatine tonsils in a patient younger than 12. Common clinical reasons include recurrent or chronic tonsillitis and enlarged tonsils associated with obstructive breathing or sleep-disordered breathing. The operation addresses the tonsils; removal of adenoid tissue is a separate distinction in code selection.
Select this code based on the patient’s age on the date of surgery and the documented procedure. The operative report should support removal of the palatine tonsils and identify any additional procedure, such as adenoid removal. This major surgery includes the preoperative visit on the day before and related postoperative care for 90 days. For multiple procedures in the same session, CMS pays the highest-valued procedure in full and other procedures at 50%. Do not append modifier 50. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42825
- 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 RVU3.42 · 47%
- Practice expense (office) RVU3.39 · 47%
- Malpractice RVU0.48 · 7%
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.
42825 compared with similar codes
Office rates for Kansas, from the same CMS release.
No office rate
This code includes removal of both tonsils and adenoids in a patient younger than 12. Choose 42825 when the documented operation removes the tonsils only.
No office rate
This code reports adenoid removal without tonsil removal. It is not the choice when the surgeon removes the palatine tonsils.
Compare 42825 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
Kansas →
Office / nonfacility
Unavailable
Facility
$224.67
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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 42825 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
5,081
- Code
- 42825
- Physician work
- 3.42
- Practice expense
- 3.39
- Malpractice
- 0.48
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.42 | × 1.000 | 3.4200 |
| Practice expense | 3.39 | × 0.904 | 3.0646 |
| Malpractice | 0.48 | × 0.504 | 0.2419 |
| Total RVUs | 6.7265 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kansas$224.67
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.42 | 1 |
| Practice expense | 3.39 | 0.904 |
| Malpractice | 0.48 | 0.504 |
(3.42 × 1 + 3.39 × 0.904 + 0.48 × 0.504) × $33.4009 = $224.67
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.
42825 billing questions
How does this code differ from 42826?
Both report tonsil removal, but 42825 is for patients younger than 12. Use 42826 for patients age 12 or older.
Can modifier 50 be reported for removal of both tonsils?
No. The CMS bilateral adjustment does not apply, and modifier 50 is inappropriate for this code.
When should 42820 be considered instead?
Use 42820 when the surgeon removes both the tonsils and adenoids in a patient younger than 12. This code covers tonsil removal without the adenoid procedure.
What documentation supports reporting 42825?
The operative report should document removal of the palatine tonsils, and the record should establish that the patient was younger than 12 on the surgery date.
How does the 90-day global period affect postoperative billing?
The day-before preoperative visit and related postoperative care during the 90 days after surgery are included in the global period.
Can an assistant surgeon be reported?
Assistant-at-surgery payment is available only when the record documents medical necessity. Co-surgeons and team surgery are 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.
5,07842815,,Excision of neck cyst,A,,7.13,6.14,NA,6.14,,1.05,14.32,14.32,0,090,0.09,0.81,0.10,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,07942820,,Remove tonsils and adenoids,A,,4.11,3.11,NA,3.11,,0.59,7.81,7.81,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08042821,,Remove tonsils and adenoids,A,,4.25,3.29,NA,3.29,,0.61,8.15,8.15,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08142825,,Removal of tonsils,A,,3.42,3.39,NA,3.39,,0.48,7.29,7.29,0,090,0.09,0.81,0.10,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5,08242826,,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
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
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958