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TONSIL REIMBURSEMENT FACT SHEET 2008
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CPT code1 Procedure National Average Medicare Payment2
42820 Tonsillectomy and adenoidectomy; under age 12 $268.51
42821 Tonsillectomy and adrenoidectomy; age 12 or over $281.84
42825 Tonsillectomy, primary or secondary; under age 12 $241.09
42826 Tonsillectomy, primary or secondary; age 12 or over $233.09
42830 Adenoidectomy, primary; under age 12 $190.05
42831 Adenoidectomy, primary; age 12 or over $205.29
42835 Adenoidectomy, secondary; under age 12 $166.82
42836 Adenoidectomy, secondary; age 12 or over $224.71
42870 Excision or destruction lingual tonsil, any method (separate procedure) $528.27
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