CPT code 42830: Adenoid removal2026 Medicare rate & RVUs in Virginia
Reports a first operation to remove adenoid tissue in a patient younger than 12, such as for nasopharyngeal obstruction or sleep-disordered breathing.
CMS doesn’t publish an office rate for 42830 in Virginia.
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 42830 covers
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.
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.
Where 42830 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | Unavailable | $218.67 |
| Virginia | Unavailable | $190.02 |
How the 42830 rate is calculated
Each of 42830’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 · 42830
RVUs × geographic indexes × conversion factor
Work2.58
2.58 RVUs× 1.000 GPCI
Practice expense2.89
2.89 RVUs× 1.000 GPCI
Malpractice0.38
0.38 RVUs× 1.000 GPCI
Adjusted RVUs
5.8500
Conversion factor
$33.4009
Medicare rate
$195.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 42830
42830 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 42830
Adenoid removal
| 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 · 42830
Adenoid removal
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
42830 without 51 · national facility
$195.40
Adenoid removal
42830-51 · Second procedure: 50%
$97.70
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%).
42830 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 42831Adenoidectomy
- 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.
- 42835Adenoid removal
- Both describe a primary adenoid operation, but 42835 applies at age 12 or older; 42830 applies below age 12.
- 42820Tonsil and adenoid removal
- 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.
- 42825Tonsillectomy
- 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.
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 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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