# CPT 42825: Tonsillectomy alone, under age 12

Medicare 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.

Web page: https://www.med-reveal.com/rates/42825-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Otolaryngology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $243.49 |
| National facility | $243.49 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| 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 | $258.23 | $258.23 |
| Connecticut | $257.86 | $257.86 |
| Illinois | $254.68 | $254.68 |
| Hawaii | $252.26 | $252.26 |
| Maryland | $251.04 | $251.04 |
| 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 |

## 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
- 42821: Tonsillectomy and adenoidectomy, age 12 or over — https://www.med-reveal.com/rates/42821-cpt-fee-schedule

Commercial negotiated rates for 42825 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