CPT 42826

Tonsillectomy Primary/Secondary Age 12/>

CPT 42826 pays $231.47 in a non-facility setting and $231.47 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $209.14 in Arkansas to $287.09 in Alaska, a 37% spread.

National non-facility rate

$231.47

Office and other outpatient settings

Facility rate
$231.47

Hospital and ASC settings

Highest state
$287.09

Alaska

Lowest state
$209.14

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 $231.47
CPT 42826 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $231.47, national facility $231.47.
StateRate compared visuallyNon-facilityFacility
Alaska
$287.09$287.09
District of Columbia
$257.71$257.71
New York
$254.48$254.48
New Jersey
$251.57$251.57
California
$247.07$247.07
Florida
$246.99$246.99
Washington
$246.07$246.07
Connecticut
$245.03$245.03
Massachusetts
$244.90$244.90
Illinois
$242.98$242.98
Hawaii
$238.86$238.86
Maryland
$238.56$238.56
Colorado
$235.91$235.91
Rhode Island
$235.27$235.27
New Hampshire
$233.70$233.70
Oregon
$233.45$233.45
Puerto Rico
$232.36$232.36
Virgin Islands
$232.36$232.36
Michigan
$231.71$231.71
Pennsylvania
$231.47$231.47
Montana
$231.44$231.44
Georgia
$230.04$230.04
Texas
$229.35$229.35
Delaware
$229.17$229.17
Nevada
$228.89$228.89
Wyoming
$227.30$227.30
New Mexico
$226.12$226.12
Arizona
$225.96$225.96
Virginia
$225.00$225.00
West Virginia
$224.86$224.86
Utah
$223.64$223.64
Louisiana
$223.24$223.24
Minnesota
$223.17$223.17
Missouri
$222.72$222.72
Ohio
$222.62$222.62
Vermont
$222.52$222.52
North Dakota
$221.94$221.94
South Carolina
$221.22$221.22
Maine
$220.89$220.89
South Dakota
$220.82$220.82
North Carolina
$218.77$218.77
Kentucky
$218.65$218.65
Oklahoma
$216.85$216.85
Wisconsin
$216.04$216.04
Indiana
$215.69$215.69
Idaho
$214.76$214.76
Tennessee
$214.65$214.65
Kansas
$213.61$213.61
Nebraska
$213.55$213.55
Iowa
$213.03$213.03
Mississippi
$212.94$212.94
Alabama
$211.61$211.61
Arkansas
$209.14$209.14

Billed by 1 specialties

Commercial rates for 42826

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

See negotiated rates