CPT 42820 is removal of the tonsils and adenoids in a child under 12, done for repeated throat infections or, more often today, for sleep-disordered breathing. It is an outpatient operation under general anesthesia, about 30 to 45 minutes, with one to two weeks of sore throat afterward.
What the price covers
The hospital's price is the facility fee for the operating room, anesthesia equipment, nursing, supplies and recovery. The ENT surgeon and the anesthesiologist bill separately. Children with sleep apnea or under three are sometimes kept overnight, which adds an observation charge.
Why prices vary
Children's hospitals and academic centers list the highest prices for this operation; community hospitals and ambulatory surgery centers list lower. The spread within a metro area is commonly three to five times for the facility fee alone.
Questions to ask
- What is the self-pay price for 42820, and what do surgeon and anesthesia add?
- Will my child need to stay overnight, and what does that cost?
- Can it be done at an ambulatory surgery center?