Tonsillectomy: how much does Medicare pay?

Nationally, the Q3 2026 Physician Fee Schedule pays $260.86 in an office (non-facility) setting and $260.86 in a facility setting for 42820. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.

Procedure · Updated Aug 1, 2026

Tonsillectomy: CPT code and Medicare rate

Removal of the tonsils together with the adenoids in a patient under 12, done for recurrent throat infections or for airway obstruction from enlarged tissue.

Also called: tonsil removal, tonsils out, tonsillectomy and adenoidectomy.

Usually billed as

42820 Tonsillectomy and Adenoidectomy, Under Age 12

Office (non-facility): $260.86
Facility: $260.86

National amounts for the Q3 2026 release (July 1 – September 30, 2026), using geographic index values of 1.000. Your local rate differs — open the code page for the locality breakdown.

The code depends on the patient's age and on whether the adenoids come out too, so an adult tonsillectomy is reported differently.

Common questions

Tonsillectomy: which code is it?: 42820 — Tonsillectomy and Adenoidectomy, Under Age 12. Removal of the tonsils together with the adenoids in a patient under 12, done for recurrent throat infections or for airway obstruction from enlarged tissue.
Tonsillectomy: how much does Medicare pay?: Nationally, the Q3 2026 Physician Fee Schedule pays $260.86 in an office (non-facility) setting and $260.86 in a facility setting for 42820. Your local amount differs — the national figure applies geographic index values of 1.000, and Medicare then pays 80% of the allowed amount after the deductible is met.
Tonsillectomy: what else affects the billing?: The code depends on the patient's age and on whether the adenoids come out too, so an adult tonsillectomy is reported differently.

Need the rate where you practice?

Every code page carries the full locality breakdown, the RVU and GPCI inputs, and the release that answered.

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This page maps everyday language to the code a claim normally carries. It is general information about how Medicare prices a service, not coding advice for a specific claim — the correct code always depends on what was actually documented and performed.

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