No office rate
Use 42831 when the patient younger than 12 has had a prior adenoid operation and the current procedure is secondary; 42830 is for the primary operation.
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CMS RVU26D · Effective 2026-10-01
42830 Adenoid removal Medicare reimbursement rates in Maine
Reports a first operation to remove adenoid tissue in a patient younger than 12, such as for nasopharyngeal obstruction or sleep-disordered breathing. Compare 42830 office and facility rates across CMS payment localities in Maine.
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 42830 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$182.88–$189.84
2 of 2 localities have a supported rate.
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 42830: Primary adenoid removal, younger than 12
Reports a first operation to remove adenoid tissue in a patient younger than 12, such as for nasopharyngeal obstruction or sleep-disordered breathing.
An otolaryngologist removes adenoid tissue from the nasopharynx during a first adenoid operation for a patient younger than 12. Common clinical reasons include enlarged adenoids contributing to nasal obstruction, sleep-disordered breathing, or recurrent adenoid-related symptoms. The procedure is generally performed in an operating room under anesthesia; the operative report should establish that adenoid tissue was removed and whether this was the patient’s first adenoid operation.
Select this code for a primary adenoid procedure in a patient younger than 12. When tonsils are also removed in the same operation, use the age-appropriate combined tonsil-and-adenoid code rather than reporting this code as the adenoid portion. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of 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. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 42830
- 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 RVU2.58 · 44%
- Practice expense (office) RVU2.89 · 49%
- Malpractice RVU0.38 · 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.
42830 compared with similar codes
Office rates for Maine, from the same CMS release.
No office rate
Both describe a primary adenoid operation, but 42835 applies at age 12 or older; 42830 applies below age 12.
No office rate
Use 42820 when tonsils and adenoids are removed together in a patient younger than 12. Use 42830 when the operation removes adenoids without the combined tonsil procedure.
No office rate
42825 covers tonsil removal alone. It does not describe adenoid removal, which is the service reported with 42830 when performed as a primary operation below age 12.
Compare 42830 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
Unavailable
Facility
$182.88
Southern Maine →
Office / nonfacility
Unavailable
Facility
$189.84
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42830 billing questions
How is this code distinguished from 42831?
This code is for a first adenoid operation in a patient younger than 12. Code 42831 describes a secondary adenoid operation in that age group.
When should the combined tonsil-and-adenoid code be used?
When both the tonsils and adenoids are removed during the same operation, select the combined code for the patient’s age rather than reporting this code for the adenoid work.
Can modifier 50 be appended?
No. The CMS bilateral adjustment does not apply to this code; modifier 50 is inappropriate for adenoid removal.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
What documentation supports reporting this code?
Document the patient’s age, the clinical reason for surgery, that the procedure was a first adenoid operation, and the operative findings and removal of adenoid tissue.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in the session are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment requires documented medical necessity.
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.
5,08042821,,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
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