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    v1.0.30
    OpenPayerBilling CodesExcision and Destruction Procedures on the Pharynx, Adenoids, and TonsilsCPT cpt-42821-tonsillectomy-adenoidectomy-age-12-plus
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    CPT 42821: Tonsillectomy with Adenoidectomy, Age 12 or Older

    Medicare pays $278 on average nationally for this procedure.

    CPT code 42821 describes removal of the tonsils and adenoids (tonsillectomy with adenoidectomy) for a patient aged 12 years or older, a surgical ENT procedure typically performed in an operating room or ambulatory surgical center and classified as an otolaryngology procedure for airway and recurrent infection indications. This service involves excision of palatine tonsils and adenoid tissue under general anesthesia and is documented as a major surgical procedure with operative note, consent, and postoperative care instructions.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adolescent or adult age 12 years or older presenting with chronic or recurrent tonsillitis, obstructive sleep-disordered breathing due to tonsillar hypertrophy, or chronic adenotonsillar hypertrophy causing dysphagia or recurrent otitis media. The workflow begins with an office evaluation by an otolaryngologist (ENT) including history, physical exam, and review of prior medical therapy. Indications are documented, informed consent obtained, and preoperative assessment completed (anesthesia evaluation, labs as indicated). On the day of surgery the patient undergoes general anesthesia in an ambulatory surgery center or hospital operating room. The surgeon performs a bilateral tonsillectomy with adenoidectomy using an appropriate technique (cold steel, electrocautery, coblation, or harmonic scalpel) for hemostasis and removal. Postoperative recovery includes airway monitoring, analgesia, and discharge instructions; some patients may require overnight observation if comorbidities or complications are present. Billing uses 42821 for tonsillectomy with adenoidectomy in patients aged 12 or older, with appropriate diagnosis linkage and modifier usage for billing circumstances.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    42820Tonsillectomy, primary; younger than 12 yearsPediatric-age counterpart to 42821; used for patients under 12.
    00170Anesthesia for tonsillectomy, adenoidectomy and/or uvulopalatopharyngoplastyAnesthesia coding used in conjunction with 42821 for reimbursement of anesthesia services (note: anesthesia CPTs vary by payer and setting).
    40301Adenoidectomy, curettage and/or cauterization (separate procedure)Sometimes adenoidectomy technique or billing variation; used when adenoidectomy is reported separately or coded in different settings.
    99223Initial hospital care, typically 70 minutes or moreUsed for inpatient preoperative evaluation for medically complex patients undergoing 42821.
    99024Postoperative follow-up visit global period, included in global surgical packageRepresents routine postoperative visits included in the global period for 42821; use only if payer requires separate reporting.

    Related Modifiers

    13 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 13

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207K00000X
    207L00000X
    207P00000X
    208000000X
    364S00000X
    207KA0200X
    2471M1202X
    225100000X

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-42800-OROPHARYNGEAL-BIOPSY

    CPT 42800: Biopsy, Oropharynx

    CPT-42804-NASOPHARYNGEAL-LESION-BIOPSY

    CPT 42804: Biopsy of Visible Nasopharyngeal Lesion

    CPT-42806-NASOPHARYNGEAL-BIOPSY-UNKNOWN-PRIMARY-LESION

    CPT 42806: Biopsy of Nasopharyngeal Lesion, Unknown Primary

    CPT-42808-PHARYNGEAL-LESION-DESTRUCTION-LASER-CRYOSURGERY

    CPT 42808: Pharynx Lesion Destruction (Laser, Cryosurgery, Electrocautery)

    CPT-42809-PHARYNX-FOREIGN-BODY-REMOVAL

    CPT 42809: Removal of Foreign Body from Pharynx

    CPT-42810-BRACHIAL-CLEFT-CYST-EXCISION

    CPT 42810: Excision of Brachial Cleft Cyst, Lateral Neck

    CPT-42815-BRACHIAL-CLEFT-CYST-EXCISION

    CPT 42815: Excision of Brachial Cleft Cyst, Lateral Neck

    CPT-42820-TONSILLECTOMY-AND-ADENOIDECTOMY-YOUNGER-THAN-12

    CPT 42820: Tonsillectomy and Adenoidectomy, Patient Younger Than 12 Years

    CPT-42825-PEDIATRIC-TONSILLECTOMY-UNDER-12

    CPT 42825: Tonsillectomy in Patients Under 12 Years

    CPT-42826-TONSILLECTOMY-AGE-12-AND-OLDER

    CPT 42826: Tonsillectomy for Patients Age 12 and Older

    Showing 1–10 of 22

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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