# CPT 42826: Tonsillectomy alone, age 12 or over

Medicare 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.

Web page: https://www.med-reveal.com/rates/42826-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Otolaryngology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $231.47 |
| National facility | $231.47 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $287.09 | $287.09 |
| District of Columbia | $257.71 | $257.71 |
| New York | $254.49 | $254.49 |
| New Jersey | $251.58 | $251.58 |
| California | $247.07 | $247.07 |
| Florida | $246.99 | $246.99 |
| Washington | $246.07 | $246.07 |
| Connecticut | $245.03 | $245.03 |
| Massachusetts | $244.91 | $244.91 |
| Illinois | $242.99 | $242.99 |
| 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 | $233.46 | $233.46 |
| 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 | $223.25 | $223.25 |
| 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 |

## 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 42826 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