CPT 42820
Tonsillectomy and adenoidectomy, patient younger than 12
Last reviewed August 2026 · DataLily AI data team
What does CPT 42820 mean?
CPT 42820 reports removal of both the tonsils and the adenoids in a patient younger than age 12. The same combined procedure at age 12 or over is 42821; tonsillectomy alone is reported with 42825 or 42826.
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CPT 42820 at a glance
- Code
- 42820
- Code type
- CPT/HCPCS
- Short descriptor
- Remove tonsils and adenoids
- Category
- ASC Surgical
- ASC eligibility
- ASC-eligible (surgical)
- Typical setting
- Ambulatory surgery center (POS 24) or hospital outpatient department (POS 22).
- Medicare ASC rate
- $3,025.62 national · 2026Q2
What is CPT code 42820?
CPT 42820 reports removal of both the tonsils and the adenoids in a patient younger than age 12. The same combined procedure at age 12 or over is 42821; tonsillectomy alone is reported with 42825 or 42826. Its official short descriptor is "Remove tonsils and adenoids", and in the ASC context it is grouped under ASC Surgical.
Is CPT 42820 eligible in an ambulatory surgery center (ASC)?
CPT 42820 can be performed in a certified ambulatory surgery center.
Where is CPT 42820 typically performed?
Ambulatory surgery center (POS 24) or hospital outpatient department (POS 22).
What is the Medicare ASC payment rate for CPT 42820?
The national Medicare ASC payment rate for CPT 42820 is $3,025.62 (Medicare ASC Payment System, 2026Q2). This is the national, unadjusted Medicare amount; the amount an individual ambulatory surgery center is paid is adjusted for local wage index and may differ. It reflects Medicare's facility payment only and does not include the surgeon's professional fee.
Which specialties use CPT 42820?
CPT 42820 is most associated with General Surgery, Otolaryngology (ENT).
Reference information about ASC eligibility and typical procedure setting. Codes, descriptors, and ASC-eligibility status change over time. This is a coding reference, not billing, coding, or legal advice. Always verify against current guidance and individual payer policy before scheduling or billing. CPT is a registered trademark of the American Medical Association. Read the DataLily AI data methodology.