CPT 42825

Tonsillectomy Primary/Secondary <Age 12

CPT 42825 pays $243.49 in a non-facility setting and $243.49 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $219.75 in Arkansas to $300.77 in Alaska, a 37% spread.

National non-facility rate

$243.49

Office and other outpatient settings

Facility rate
$243.49

Hospital and ASC settings

Highest state
$300.77

Alaska

Lowest state
$219.75

Arkansas · 37% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $243.49
CPT 42825 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $243.49, national facility $243.49.
StateRate compared visuallyNon-facilityFacility
Alaska
$300.77$300.77
District of Columbia
$271.63$271.63
New York
$267.76$267.76
New Jersey
$264.96$264.96
California
$261.00$261.00
Washington
$259.56$259.56
Florida
$259.05$259.05
Massachusetts
$258.22$258.22
Connecticut
$257.86$257.86
Illinois
$254.68$254.68
Hawaii
$252.26$252.26
Maryland
$251.03$251.03
Colorado
$248.60$248.60
Rhode Island
$247.67$247.67
New Hampshire
$246.13$246.13
Oregon
$246.03$246.03
Puerto Rico
$244.50$244.50
Virgin Islands
$244.50$244.50
Montana
$243.46$243.46
Pennsylvania
$243.31$243.31
Michigan
$243.12$243.12
Georgia
$241.61$241.61
Texas
$241.23$241.23
Delaware
$241.09$241.09
Nevada
$240.93$240.93
Wyoming
$239.32$239.32
Arizona
$237.67$237.67
New Mexico
$237.32$237.32
Virginia
$236.85$236.85
West Virginia
$235.57$235.57
Minnesota
$235.49$235.49
Utah
$235.06$235.06
Vermont
$234.44$234.44
Louisiana
$234.40$234.40
North Dakota
$233.97$233.97
Missouri
$233.92$233.92
Ohio
$233.77$233.77
South Dakota
$232.85$232.85
South Carolina
$232.48$232.48
Maine
$232.47$232.47
North Carolina
$230.12$230.12
Kentucky
$229.56$229.56
Oklahoma
$227.80$227.80
Wisconsin
$227.64$227.64
Indiana
$226.99$226.99
Idaho
$225.99$225.99
Tennessee
$225.77$225.77
Nebraska
$224.80$224.80
Kansas
$224.67$224.67
Iowa
$224.20$224.20
Mississippi
$223.57$223.57
Alabama
$222.38$222.38
Arkansas
$219.75$219.75

Billed by 1 specialties

Commercial rates for 42825

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates