Surgery & Procedures
CPT Code 42826
Tonsillectomy, age 12 or over
National Average Rate
$3,200.00
CMS non-facility rate
Facility Rate
$2,560.00
Hospital / outpatient facility
Data Source
CMS Medicare
Physician Fee Schedule 2024
What This Means for Your Bill
- Medicare pays $3200.00 nationally for CPT 42826 in a non-facility (office) setting.
- In a hospital or outpatient facility the rate drops to $2560.00 because the facility bills separately.
- Private insurers typically pay 110–140% of the Medicare rate, so a fair price is roughly $4,000–$4,480.
- If your bill shows a charge significantly above this, you may have grounds to negotiate or dispute it.
How to Use This Information
1
Find CPT 42826 on your itemized bill — hospitals are required to provide one on request.
2
Compare the charged amount to $3200.00 — if your bill is 2× or more, that's a red flag.
3
Use our AI bill analyzer to scan your full bill, flag errors, and get a dispute letter in under 2 minutes.
Was CPT 42826 on Your Bill?
Upload your bill and our AI will check if you were charged fairly — free in under 2 minutes.
Scan My Bill Free →Related Tools
Look up another CPT code