# CPT 42831: Adenoidectomy Primary Age 12/>

Medicare CPT 42831 pays $212.76 in a non-facility setting and $212.76 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $191.07 in Arkansas to $259.54 in Alaska, a 36% spread.

Web page: https://www.med-reveal.com/rates/42831-cpt-fee-schedule
Section: Surgery and Procedures
Billed by: Otolaryngology

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $212.76 |
| National facility | $212.76 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $259.54 | $259.54 |
| District of Columbia | $238.42 | $238.42 |
| New York | $234.38 | $234.38 |
| New Jersey | $232.18 | $232.18 |
| California | $229.70 | $229.70 |
| Washington | $227.93 | $227.93 |
| Massachusetts | $226.61 | $226.61 |
| Florida | $225.77 | $225.77 |
| Connecticut | $225.71 | $225.71 |
| Hawaii | $221.92 | $221.92 |
| Illinois | $221.61 | $221.61 |
| Maryland | $219.58 | $219.58 |
| Colorado | $217.84 | $217.84 |
| Rhode Island | $216.62 | $216.62 |
| Oregon | $215.57 | $215.57 |
| New Hampshire | $215.52 | $215.52 |
| Puerto Rico | $213.75 | $213.75 |
| Virgin Islands | $213.75 | $213.75 |
| Montana | $212.74 | $212.74 |
| Pennsylvania | $212.30 | $212.30 |
| Michigan | $211.63 | $211.63 |
| Texas | $210.65 | $210.65 |
| Nevada | $210.64 | $210.64 |
| Delaware | $210.58 | $210.58 |
| Georgia | $210.57 | $210.57 |
| Wyoming | $209.29 | $209.29 |
| Arizona | $207.50 | $207.50 |
| Virginia | $207.00 | $207.00 |
| Minnesota | $206.49 | $206.49 |
| New Mexico | $206.49 | $206.49 |
| Vermont | $205.08 | $205.08 |
| Utah | $204.93 | $204.93 |
| North Dakota | $204.83 | $204.83 |
| West Virginia | $204.39 | $204.39 |
| Louisiana | $204.01 | $204.01 |
| South Dakota | $203.89 | $203.89 |
| Missouri | $203.67 | $203.67 |
| Ohio | $203.48 | $203.48 |
| Maine | $202.97 | $202.97 |
| South Carolina | $202.56 | $202.56 |
| North Carolina | $200.71 | $200.71 |
| Kentucky | $199.65 | $199.65 |
| Wisconsin | $198.99 | $198.99 |
| Oklahoma | $198.24 | $198.24 |
| Indiana | $198.02 | $198.02 |
| Idaho | $197.09 | $197.09 |
| Tennessee | $196.76 | $196.76 |
| Nebraska | $196.15 | $196.15 |
| Kansas | $195.78 | $195.78 |
| Iowa | $195.54 | $195.54 |
| Mississippi | $194.28 | $194.28 |
| Alabama | $193.48 | $193.48 |
| Arkansas | $191.07 | $191.07 |

## Related codes

- 10140: I&d Hematoma Seroma/fluid Collection — https://www.med-reveal.com/rates/10140-cpt-fee-schedule
- 11055: Paring/cutting Benign Hyperkeratotic Lesion 1 — https://www.med-reveal.com/rates/11055-cpt-fee-schedule
- 11056: Paring/cutting Benign Hyperkeratotic Lesion 2-4 — https://www.med-reveal.com/rates/11056-cpt-fee-schedule
- 11057: Paring/cutting Benign Hyperkeratotic Lesion >4 — https://www.med-reveal.com/rates/11057-cpt-fee-schedule
- 11403: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 2.1-3.0 Cm — https://www.med-reveal.com/rates/11403-cpt-fee-schedule
- 11404: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l 3.1-4.0 Cm — https://www.med-reveal.com/rates/11404-cpt-fee-schedule
- 11406: Exc B9 Lesion Mrgn Xcp Sk Tg T/a/l >4.0 Cm — https://www.med-reveal.com/rates/11406-cpt-fee-schedule
- 11603: Excision Mal Lesion Trunk/arm/leg 2.1-3.0 Cm — https://www.med-reveal.com/rates/11603-cpt-fee-schedule

Commercial negotiated rates for 42831 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