Headline: CPT code 42826: Tonsillectomy for Patients Aged 12 Years and Older

Lead: CPT code 42826 identifies an initial, recurrent, or secondary tonsillectomy performed in patients who are 12 years of age or older. This surgical code is relevant to otolaryngology practices, ambulatory surgery centers, and hospital surgical departments and affects national billing patterns for common airway and infection-related indications.

CPT code 42826 represents the standardized billing descriptor for adult and adolescent tonsil removal when the patient is 12 years or older. Nationally, this code matters because tonsillectomy remains a frequently performed ENT surgery with implications for surgical capacity, anesthesia services, and reimbursement across public and commercial payers. The code is used for primary, repeat, and secondary procedures, ensuring consistent reporting for clinical and administrative workflows.

Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and the payer scope included in this review. The publication outlines expected benchmarks and coding considerations, highlights recent policy or coverage updates where applicable, and situates CPT code 42826 within common surgical service lines.

This summary is intended for billing managers, surgical administrators, and policy analysts seeking a national perspective on coding, coverage, and the clinical framing of tonsillectomy in patients aged 12 and older.