Billing code 42831: AdenoidectomyMedicare rate & RVUs in Ohio
Reports primary removal of adenoid tissue in a patient age 12 or older, commonly for obstructive symptoms or recurrent adenoid-related disease.
CMS doesn’t publish an office rate for 42831 in Ohio.
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 42831 covers
An otolaryngologist removes adenoid tissue located behind the nasal cavity, commonly to address nasal blockage, sleep-disordered breathing, or recurrent adenoid-related inflammation. The procedure is generally performed in a surgical facility under anesthesia. This code identifies a primary adenoidectomy in a patient who is at least 12 years old; it is not the code for repeat removal of residual or regrown tissue.
Choose the code based on the patient’s age and whether the adenoidectomy is primary or secondary. The operative report should support removal of adenoid tissue and the procedure’s primary status. CMS treats the service as major surgery with a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same 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.
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.
42831 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $203.48 |
How the 42831 rate is calculated
Each of 42831’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 · 42831
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.74Practice expense 3.23Malpractice 0.40
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42831
42831 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42831
Adenoidectomy
| 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 · 42831
Adenoidectomy
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
42831 without 51 · national facility
$212.76
Adenoidectomy
42831-51 · Second procedure: 50%
$106.38
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%).
42831 compared with similar codes
Compare codes
42831 vs 42830 vs 42836 vs 42821: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42830Adenoid removal
- Both are primary adenoidectomies; 42831 is for patients age 12 or older, while 42830 is for patients younger than 12.
- 42836Adenoid removal
- 42836 is for secondary adenoidectomy in a patient age 12 or older, such as repeat removal; 42831 is for primary removal.
- 42821Tonsil and adenoid removal
- Use 42821 when both tonsils and adenoids are removed in a patient age 12 or older; 42831 describes primary adenoid removal alone.
42831 billing questions
How does 42831 differ from 42830?
Both describe primary adenoidectomy. Use 42831 for a patient age 12 or older and 42830 for a patient younger than 12.
When is 42836 used instead?
42836 describes secondary adenoidectomy for a patient age 12 or older, such as a repeat procedure for residual or regrown adenoid tissue. Code 42831 is for primary removal.
Should 42831 be reported with a tonsillectomy code when both are removed?
When the surgeon removes both the adenoids and tonsils, compare the age-appropriate combined adenotonsillectomy code, 42821 for age 12 or older, rather than treating the services as adenoidectomy alone.
Can modifier 50 be appended for adenoid removal?
No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate.
What documentation supports reporting 42831?
The operative report should document primary removal of adenoid tissue, and the record should establish that the patient was at least 12 years old on the service date.
When is assistant-at-surgery payment allowed?
CMS allows assistant-at-surgery payment only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
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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