CPT 42821
Global 090 ActiveRemove tonsils and adenoids
CPT 42821 Billing & Documentation Guide
CPT code 42821 (Remove tonsils and adenoids) is classified under Surgery (Digestive) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.25, a non-facility practice expense RVU of 3.29, and a malpractice RVU of 0.61, a total non-facility RVU of 8.15 and facility RVU of 8.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $276.98, though rates vary from $246.84 to $341.19 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 42821, 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 42821 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 42821 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 42821
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.25 | 4.25 |
| Practice Expense RVU | 3.29 | 3.29 |
| Malpractice RVU | 0.61 | 0.61 |
| Total RVU | 8.15 | 8.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 42821
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 | $288.12 | $288.12 | $275.73 - $326.95 | 29 |
| Florida | $291.87 | $291.87 | $277.63 - $307.88 | 3 |
| Georgia | $271.38 | $271.38 | $264.26 - $278.5 | 2 |
| Illinois | $287.57 | $287.57 | $274.13 - $300.15 | 4 |
| Michigan | $273.82 | $273.82 | $265.29 - $282.35 | 2 |
| North Carolina | $257.5 | $257.5 | $257.5 - $257.5 | 1 |
| New York | $298.97 | $298.97 | $260.67 - $319.53 | 5 |
| Ohio | $262.82 | $262.82 | $262.82 - $262.82 | 1 |
| Pennsylvania | $272.65 | $272.65 | $262.09 - $283.21 | 2 |
| Texas | $269.85 | $269.85 | $260.88 - $280.24 | 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 42821
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 42821 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 42821
What does CPT code 42821 mean? +
CPT code 42821 represents: Remove tonsils and adenoids. It's in the Surgery (Digestive) category with a global period of 090.
What is the Medicare reimbursement for CPT 42821? +
The 2026 Medicare national average non-facility payment for CPT 42821 is $276.98. Rates range from $246.84 to $341.19 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 42821? +
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 42821? +
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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