CG-SURG-113 Tonsillectomy with or without Adenoidectomy for Adults

This policy addresses tonsillectomy, with or without adenoidectomy, for adults (age 18+). It is medically necessary when there are recurrent acute throat infections—at least 3 episodes in 6 months or 4 in 12 months—with each episode documented to include at least one of: fever >38.3 C (100.9 F), cervical adenopathy, tonsillar exudate/erythema, or a positive Group A beta-hemolytic streptococcus test; it is not medically necessary when these criteria are not met or in any other circumstances.

"Tonsillectomy is consideredmedically necessaryfor individuals 18 years of age and older who meet one or more of the criteria below:"

Sign up to see full coverage criteria, indications, and limitations.