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CPT 42700: Incision and Drainage of Peritonsillar Abscess
CPT code 42700 represents incision and drainage of a peritonsillar abscess, a common urgent minor surgical procedure to evacuate pus adjacent to a tonsil. Nationally, this code is relevant across emergency departments, ambulatory surgical centers, and outpatient clinics where acute oropharyngeal infections are managed. Proper coding affects episode capture, quality measurement, and payment for urgent head and neck procedures.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for peritonsillar abscess drainage, typical sites of service, and coding considerations tied to procedure reporting. The report summarizes available national benchmarks where present and highlights policy and billing practice notes that influence reimbursement and claims processing.
This publication helps clinicians, coding professionals, and policy analysts understand when CPT code 42700 is used, how it fits into surgical and urgent care service lines, and what documentation and billing contexts typically accompany the procedure. Data not available in the input will be noted as such in relevant sections.
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Billing Code Overview
CPT code 42700 describes an incision and drainage of a peritonsillar abscess, where the provider uses an incision to drain an abscess adjacent to one of the tonsils. The service type is a minor surgical drainage procedure. The typical site of service is an outpatient clinic, emergency department, or ambulatory surgical center where minor procedures are performed.