Billing code 42870: Tonsil excisionMedicare rate & RVUs in Ohio
Reports surgical removal of lingual tonsil tissue, commonly for substantial enlargement at the tongue base contributing to airway obstruction or related symptoms.
CMS doesn’t publish an office rate for 42870 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 42870 covers
An otolaryngologist removes lingual tonsil tissue at the base of the tongue, usually in an operating-room setting. The service may be performed for enlarged lingual tonsils associated with airway obstruction, including in a patient being evaluated or treated for obstructive sleep apnea. The operative report should identify the lingual tonsil as the target and describe the excision; removal of palatine tonsils or a biopsy of throat tissue is a different service.
Report this code when lingual tonsil tissue is excised, not when tissue is only sampled. Documentation should establish the operative site and extent of removal. 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% multiple-procedure reduction. Modifier 50 is inappropriate for this code. 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.
42870 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $518.87 |
How the 42870 rate is calculated
Each of 42870’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 · 42870
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 5.38Practice expense 10.25Malpractice 0.79
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 42870
42870 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42870
Tonsil excision
| 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 · 42870
Tonsil excision
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
42870 without 51 · national facility
$548.44
Tonsil excision
42870-51 · Second procedure: 50%
$274.22
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%).
42870 compared with similar codes
Compare codes
42870 vs 42800 vs 42808 vs 42825 vs 42826: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 42800Biopsy
- Use 42800 for diagnostic biopsy of throat tissue. Use 42870 when lingual tonsil tissue is excised rather than sampled.
- 42808Pharyngeal lesion treatment
- 42808 addresses excision of a pharyngeal lesion. This code is specific to removal of lingual tonsil tissue at the tongue base.
- 42825Tonsillectomy
- 42825 is for removal of palatine tonsils in a younger patient. Choose 42870 when the operative target is the lingual tonsil.
- 42826Tonsillectomy
- 42826 is for removal of palatine tonsils in an older patient. It does not describe excision of lingual tonsil tissue.
42870 billing questions
How is this different from palatine tonsillectomy?
This code is for lingual tonsil tissue at the tongue base. Palatine tonsillectomy codes apply to the tonsils on the sides of the throat.
Can this code be used for a biopsy?
No. It reports excision of lingual tonsil tissue. A throat-tissue biopsy is a different service when the intent is diagnostic sampling rather than removal.
Should modifier 50 be appended for both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 should not be used.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the session are subject to the standard multiple-procedure reduction.
When may an assistant at surgery be reported?
Assistant-at-surgery payment is allowed only when medical necessity is documented. Co-surgeons and team surgery are not permitted for this code.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
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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