Quanto Custa Amigdalectomia?
Tonsillectomy is a surgical procedure to remove the tonsils, usually due to recurrent throat infections or obstructive sleep apnea. It is one of the most common surgeries performed on children and adolescents.
Sem Seguro
$5,500
Com Seguro
$1,000
Medicare
$800
Média Nacional
$2,433
By Elena Bellini, MPH, Health Policy & Management · Last reviewed 2026-04-21 ·
Sources: CMS Medicare Provider Utilization and Payment Data 2025 · Methodology · Editorial standards Visão geral
A tonsillectomy removes the palatine tonsils, most commonly in children with recurrent tonsillitis, chronic tonsillar hypertrophy causing sleep-disordered breathing, or obstructive sleep apnea. Adenoidectomy is frequently performed in the same procedure and is billed with its own code. Surgery takes 20 to 45 minutes under general anesthesia, and the patient is typically discharged the same day unless there are complicating factors such as very young age, severe sleep apnea, or significant comorbidities. Recovery is notably painful, and post-operative care includes hydration, pain management, and a specific diet progression over 10 to 14 days. Bleeding is the most feared complication and can occur up to two weeks postoperatively. Total billed amount usually includes the ENT surgeon, the facility (ASC or hospital outpatient), anesthesia, and any recovery-room care. Commercial insurers often require prior authorization with documentation of qualifying indications.
O que afeta o custo
- Site of service: ambulatory surgery centers typically charge less than hospital outpatient departments for the same tonsillectomy.
- Concurrent adenoidectomy: bundling tonsils and adenoids (T&A) is common and billed together, but separate coding adds cost over tonsillectomy alone.
- Age: children under 3, or patients with significant sleep apnea, often require overnight monitoring, which adds hospital room charges.
- Surgical technique: coblation, electrocautery, and cold-steel techniques can differ slightly in facility equipment charges.
- Anesthesia time: longer anesthesia for complex airway cases or younger children increases the anesthesia line item.
- Post-operative complications: readmission for bleeding or dehydration generates significant additional charges.
Como Economizar
- Choose an ambulatory surgery center or pediatric ASC for low-risk outpatient cases — the facility fee is often substantially lower than hospital outpatient.
- Confirm prior authorization and documentation of qualifying indications (sleep study, throat-culture frequency) before scheduling.
- Verify the ENT surgeon, anesthesiologist, and facility are all in-network to avoid surprise balance billing.
- Ask for a bundled Good Faith Estimate covering surgeon, facility, and anesthesia if self-pay.
- Schedule surgery after the family deductible is met (often late in the plan year) to maximize insurance coverage.
- Use HSA or FSA dollars for deductible and coinsurance payments.
Notas sobre seguro e cobertura
Commercial plans and Medicaid cover tonsillectomy for medically necessary indications — typically documented recurrent tonsillitis by the Paradise criteria, sleep-disordered breathing confirmed by history or sleep study, or tonsil hypertrophy causing functional problems. Prior authorization is commonly required. Medicare rarely covers tonsillectomy because adult cases are uncommon; when it does, Part A or Part B applies depending on setting. Expect to owe your deductible plus coinsurance. Surgeon, facility, and anesthesia are typically billed separately. CHIP and Medicaid programs cover tonsillectomy for eligible children at low or zero cost-sharing.
Data sources for this page
Cost figures on this page are compiled from the following sources, triangulated per the rules in our methodology:
- CMS Medicare Provider Utilization and Payment Data 2025 — primary CMS reference used as the Medicare-rate anchor.
- Hospital Price Transparency machine-readable files (HPT MRFs) from a sample of major hospitals in each state, per the federal Hospital Price Transparency rule.
- Transparency in Coverage payer in-network rate files for commercial-rate cross-validation.
- State All-Payer Claims Database (APCD) summaries where published (Colorado, New Hampshire, Massachusetts, Minnesota, Maine, Utah, Vermont, Rhode Island, Washington, Oregon).
Last reviewed 2026-04-21. See editorial standards for our fact-checking process and correction policy.
Range: $3,950 to $7,600 · 50 states shown
Custo por Estado
| Estado | Sem Seguro | Com Seguro | Medicare |
|---|---|---|---|
| Mississippi | $3,950 | $720 | $580 |
| Arkansas | $4,150 | $750 | $600 |
| West Virginia | $4,150 | $750 | $600 |
| Alabama | $4,300 | $780 | $620 |
| Oklahoma | $4,300 | $780 | $620 |
| Kentucky | $4,700 | $850 | $680 |
| Louisiana | $4,750 | $860 | $690 |
| Iowa | $4,850 | $880 | $700 |
| New Mexico | $4,850 | $880 | $700 |
| South Carolina | $4,850 | $880 | $700 |
| South Dakota | $4,850 | $880 | $700 |
| Kansas | $4,900 | $890 | $710 |
| North Dakota | $4,900 | $890 | $710 |
| Idaho | $4,950 | $900 | $720 |
| Nebraska | $4,950 | $900 | $720 |
| Tennessee | $4,950 | $900 | $720 |
| Indiana | $5,100 | $930 | $740 |
| Missouri | $5,100 | $930 | $740 |
| Utah | $5,100 | $930 | $740 |
| Wyoming | $5,100 | $930 | $740 |
| Georgia | $5,150 | $940 | $750 |
| North Carolina | $5,150 | $940 | $750 |
| Michigan | $5,250 | $950 | $760 |
| Montana | $5,250 | $950 | $760 |
| Arizona | $5,400 | $980 | $780 |
| Ohio | $5,400 | $980 | $780 |
| Wisconsin | $5,400 | $980 | $780 |
| Maine | $5,450 | $990 | $790 |
| Texas | $5,450 | $990 | $790 |
| Florida | $5,550 | $1,000 | $810 |
| Minnesota | $5,550 | $1,000 | $810 |
| Illinois | $5,650 | $1,050 | $820 |
| Pennsylvania | $5,650 | $1,050 | $820 |
| Delaware | $5,700 | $1,050 | $830 |
| Nevada | $5,700 | $1,050 | $830 |
| Vermont | $5,700 | $1,050 | $830 |
| Virginia | $5,700 | $1,050 | $830 |
| Colorado | $5,850 | $1,050 | $850 |
| New Hampshire | $5,850 | $1,050 | $850 |
| Oregon | $5,850 | $1,050 | $850 |
| Maryland | $6,050 | $1,100 | $880 |
| Rhode Island | $6,100 | $1,100 | $890 |
| Washington | $6,100 | $1,100 | $890 |
| Connecticut | $6,600 | $1,200 | $960 |
| New Jersey | $6,600 | $1,200 | $960 |
| California | $7,250 | $1,300 | $1,050 |
| Massachusetts | $7,300 | $1,350 | $1,050 |
| Alaska | $7,450 | $1,350 | $1,100 |
| New York | $7,450 | $1,350 | $1,100 |
| Hawaii | $7,600 | $1,400 | $1,100 |
Perguntas Frequentes
Quanto custa amigdalectomia sem seguro?
O custo médio de amigdalectomia sem seguro nos Estados Unidos é $5,500. Os custos variam significativamente por estado.
O seguro cobre amigdalectomia?
A maioria dos planos de seguro de saúde cobre amigdalectomia quando medicamente necessário. Com seguro, o custo médio do próprio bolso é $1,000.
O Medicare cobre amigdalectomia?
O Medicare Parte B geralmente cobre amigdalectomia quando prescrito por um médico. O valor médio aprovado pelo Medicare é $800.
Revisado por Elena Bellini · Última revisão: 2026-04-21
Dados obtidos de CMS Medicare Provider Utilization and Payment Data 2025. Última atualização: 2026-03-01. Esta informação é apenas para fins educacionais e não constitui aconselhamento médico. Este site é apenas para fins informativos e não constitui aconselhamento médico. Consulte sempre um profissional de saúde qualificado.