CPT Code 42831
Surgery to remove the adenoids only, age 12 or older
2026 Medicare national rate
Office (non-facility)
$212.76
Performed in a physician office
Facility
$212.76
Hospital / ASC setting
Total RVUs (office)
6.37
6.37 facility
Conversion factor
$33.4009
2026 PFS
Medicare payment = total RVUs × GPCI (locality adjustment) × conversion factor. At the national level (GPCI = 1.0), 6.37 × 33.4009 = $212.76 (office). Facility rates are lower because the facility separately bills its overhead.
RVU breakdown
Work RVU
2.74
Office PE RVU
3.23
Facility PE RVU
3.23
Malpractice RVU
0.40
PC/TC: Physician service — not subject to a professional/technical split.
Billing notes
- 42831 carries a 90-day global period: related follow-up care within 90 days is bundled into this payment and is not separately billable.
- The national allowable is built from 6.37 total office RVUs × the $33.4009 conversion factor; multiply by your locality GPCIs (above) to reconcile a specific remittance.
Billing & payment rules
- Multiple procedures
- Standard multiple-procedure reduction applies (100% / 50% / 50%…).
- Assistant surgeon
- Assistant surgeon payable only with documented medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgeons
- Team surgeons not permitted.
- Global period
- 90-day global period — most related follow-up care within 90 days is bundled into this code's payment.
2026 rate by locality
| Locality | Office | Facility |
|---|---|---|
| National (GPCI 1.0) | $212.76 | $212.76 |
| Manhattan, NY | $243.93 | $243.93 |
| Los Angeles, CA | $231.77 | $231.77 |
| Houston, TX | $217.76 | $217.76 |
| Chicago, IL | $231.25 | $231.25 |
| Miami, FL | $237.62 | $237.62 |
| Atlanta, GA | $217.45 | $217.45 |
Computed from CMS 2026 GPCIs: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × $33.4009. Your MAC's locality may differ.
Related Surgery codes
Related guides
Medical billing disclaimer
Rates shown are 2026 Physician Fee Schedule amounts and are for educational reference. Commercial payers, locality, and plan rules vary. Always verify current rates and coverage with the payer before billing. D3rx is not responsible for claim outcomes.