# CPT 42821: Tonsillectomy and adenoidectomy, age 12 or over

Medicare CPT 42821 pays $272.22 in a non-facility setting and $272.22 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $246.84 in Arkansas to $341.19 in Alaska, a 38% spread.

Web page: https://www.med-reveal.com/rates/42821-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Otolaryngology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $272.22 |
| National facility | $272.22 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $341.19 | $341.19 |
| District of Columbia | $301.75 | $301.75 |
| New York | $298.97 | $298.97 |
| New Jersey | $295.06 | $295.06 |
| Florida | $291.87 | $291.87 |
| California | $288.12 | $288.12 |
| Connecticut | $287.80 | $287.80 |
| Washington | $287.77 | $287.77 |
| Illinois | $287.57 | $287.57 |
| Massachusetts | $286.65 | $286.65 |
| Maryland | $280.31 | $280.31 |
| Hawaii | $278.69 | $278.69 |
| Colorado | $276.49 | $276.49 |
| Rhode Island | $276.34 | $276.34 |
| New Hampshire | $274.18 | $274.18 |
| Michigan | $273.82 | $273.82 |
| Oregon | $273.60 | $273.60 |
| Puerto Rico | $273.12 | $273.12 |
| Virgin Islands | $273.12 | $273.12 |
| Pennsylvania | $272.65 | $272.65 |
| Montana | $272.18 | $272.18 |
| Georgia | $271.38 | $271.38 |
| Texas | $269.84 | $269.84 |
| Delaware | $269.55 | $269.55 |
| Nevada | $268.92 | $268.92 |
| New Mexico | $267.19 | $267.19 |
| Wyoming | $266.92 | $266.92 |
| West Virginia | $266.60 | $266.60 |
| Arizona | $265.88 | $265.88 |
| Virginia | $264.36 | $264.36 |
| Louisiana | $263.61 | $263.61 |
| Utah | $263.55 | $263.55 |
| Missouri | $262.85 | $262.85 |
| Ohio | $262.82 | $262.82 |
| Minnesota | $261.06 | $261.06 |
| Vermont | $261.05 | $261.05 |
| South Carolina | $260.81 | $260.81 |
| North Dakota | $260.11 | $260.11 |
| Maine | $259.71 | $259.71 |
| South Dakota | $258.69 | $258.69 |
| Kentucky | $258.29 | $258.29 |
| North Carolina | $257.50 | $257.50 |
| Oklahoma | $255.92 | $255.92 |
| Indiana | $253.72 | $253.72 |
| Wisconsin | $253.50 | $253.50 |
| Tennessee | $252.78 | $252.78 |
| Idaho | $252.69 | $252.69 |
| Mississippi | $251.63 | $251.63 |
| Kansas | $251.56 | $251.56 |
| Nebraska | $251.08 | $251.08 |
| Iowa | $250.59 | $250.59 |
| Alabama | $249.64 | $249.64 |
| Arkansas | $246.84 | $246.84 |

## 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
- 42820: Tonsillectomy and adenoidectomy, under age 12 — https://www.med-reveal.com/rates/42820-cpt-fee-schedule
- 42825: Tonsillectomy alone, under age 12 — https://www.med-reveal.com/rates/42825-cpt-fee-schedule

Commercial negotiated rates for 42821 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