# CPT 42820: Tonsillectomy and adenoidectomy, under age 12

Medicare CPT 42820 pays $260.86 in a non-facility setting and $260.86 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $236.66 in Arkansas to $327.40 in Alaska, a 38% spread.

Web page: https://www.med-reveal.com/rates/42820-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Otolaryngology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $260.86 |
| National facility | $260.86 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $327.40 | $327.40 |
| District of Columbia | $288.99 | $288.99 |
| New York | $286.46 | $286.46 |
| New Jersey | $282.65 | $282.65 |
| Florida | $279.86 | $279.86 |
| California | $275.80 | $275.80 |
| Illinois | $275.79 | $275.79 |
| Connecticut | $275.74 | $275.74 |
| Washington | $275.57 | $275.57 |
| Massachusetts | $274.52 | $274.52 |
| Maryland | $268.59 | $268.59 |
| Hawaii | $266.80 | $266.80 |
| Colorado | $264.84 | $264.84 |
| Rhode Island | $264.77 | $264.77 |
| New Hampshire | $262.66 | $262.66 |
| Michigan | $262.56 | $262.56 |
| Oregon | $262.07 | $262.07 |
| Puerto Rico | $261.71 | $261.71 |
| Virgin Islands | $261.71 | $261.71 |
| Pennsylvania | $261.33 | $261.33 |
| Montana | $260.82 | $260.82 |
| Georgia | $260.16 | $260.16 |
| Texas | $258.60 | $258.60 |
| Delaware | $258.31 | $258.31 |
| Nevada | $257.67 | $257.67 |
| New Mexico | $256.20 | $256.20 |
| West Virginia | $255.75 | $255.75 |
| Wyoming | $255.74 | $255.74 |
| Arizona | $254.80 | $254.80 |
| Virginia | $253.30 | $253.30 |
| Louisiana | $252.75 | $252.75 |
| Utah | $252.62 | $252.62 |
| Missouri | $252.00 | $252.00 |
| Ohio | $251.98 | $251.98 |
| Vermont | $250.09 | $250.09 |
| South Carolina | $250.01 | $250.01 |
| Minnesota | $250.00 | $250.00 |
| North Dakota | $249.16 | $249.16 |
| Maine | $248.88 | $248.88 |
| South Dakota | $247.78 | $247.78 |
| Kentucky | $247.66 | $247.66 |
| North Carolina | $246.79 | $246.79 |
| Oklahoma | $245.35 | $245.35 |
| Indiana | $243.15 | $243.15 |
| Wisconsin | $242.86 | $242.86 |
| Tennessee | $242.28 | $242.28 |
| Idaho | $242.17 | $242.17 |
| Mississippi | $241.28 | $241.28 |
| Kansas | $241.11 | $241.11 |
| Nebraska | $240.61 | $240.61 |
| Iowa | $240.15 | $240.15 |
| Alabama | $239.32 | $239.32 |
| Arkansas | $236.66 | $236.66 |

## Related codes

- 40490: Biopsy of lip — https://www.med-reveal.com/rates/40490-cpt-fee-schedule
- 40650: Repair lip, vermilion only — https://www.med-reveal.com/rates/40650-cpt-fee-schedule
- 41010: Frenotomy, lingual — https://www.med-reveal.com/rates/41010-cpt-fee-schedule
- 41112: Excision of lesion of tongue — https://www.med-reveal.com/rates/41112-cpt-fee-schedule
- 41599: Unlisted procedure, tongue/floor of mouth — https://www.med-reveal.com/rates/41599-cpt-fee-schedule
- 42700: Incision and drainage of peritonsillar abscess — https://www.med-reveal.com/rates/42700-cpt-fee-schedule
- 42821: Tonsillectomy and adenoidectomy, age 12 or over — https://www.med-reveal.com/rates/42821-cpt-fee-schedule
- 42825: Tonsillectomy alone, under age 12 — https://www.med-reveal.com/rates/42825-cpt-fee-schedule

Commercial negotiated rates for 42820 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules