CPT 42700
Global 010 ActiveI&d abscess peritonsillar
CPT 42700 Billing & Documentation Guide
CPT code 42700 (I&d abscess peritonsillar) is classified under Surgery (Digestive) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.63, a non-facility practice expense RVU of 4.07, and a malpractice RVU of 0.26, a total non-facility RVU of 5.96 and facility RVU of 3.84. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $204.86, though rates vary from $175.69 to $261.11 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 42700, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 42700 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 2 units of 42700 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 42700
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.63 | 1.63 |
| Practice Expense RVU | 4.07 | 1.95 |
| Malpractice RVU | 0.26 | 0.26 |
| Total RVU | 5.96 | 3.84 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 42700
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $221.96 | $138.17 | $209.02 - $261.11 | 29 |
| Florida | $207.74 | $136.7 | $197.46 - $217.92 | 3 |
| Georgia | $194.61 | $127.05 | $186.06 - $203.15 | 2 |
| Illinois | $202.59 | $134.16 | $192.13 - $211.38 | 4 |
| Michigan | $194.32 | $127.82 | $188.36 - $200.27 | 2 |
| North Carolina | $186.83 | $120.76 | $186.83 - $186.83 | 1 |
| New York | $220.49 | $141.49 | $189.69 - $235.69 | 5 |
| Ohio | $187.31 | $122.66 | $187.31 - $187.31 | 1 |
| Pennsylvania | $197.37 | $128.02 | $187.44 - $207.3 | 2 |
| Texas | $196.64 | $126.93 | $186.22 - $206.07 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 42700
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 42700 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00170 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 42700
What does CPT code 42700 mean? +
CPT code 42700 represents: I&d abscess peritonsillar. It's in the Surgery (Digestive) category with a global period of 010.
What is the Medicare reimbursement for CPT 42700? +
The 2026 Medicare national average non-facility payment for CPT 42700 is $204.86. Rates range from $175.69 to $261.11 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 42700? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 42700? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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