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CPT code 31233: Sinus endoscopy, maxillary sinus2026 Medicare rate & RVUs in Puerto Rico

Reports diagnostic endoscopic inspection of the maxillary sinus through the nasal passage when the clinician evaluates disease within that sinus.

CMS RVU26DEffective Oct 1, 2026One payment locality3.8K Medicare services in 2024

In Puerto Rico, Medicare pays $274.51 for 31233 in the office and $117.48 when it’s performed in a hospital or facility.

$274.51Office (non-facility)
$117.48Hospital or facility
+0.7%vs the national office rate ($272.55)

Check a contract rate as a % of Medicare · 31233 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 31233 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 31233 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 31233 covers

An otolaryngologist or rhinologist passes an endoscope through the nasal cavity and into the maxillary sinus through its natural opening to inspect the sinus. The examination may help evaluate suspected maxillary sinus disease, such as persistent symptoms or an abnormal finding that requires direct visualization. This is distinct from an examination confined to the nasal cavity and from operative enlargement of the sinus opening or removal of tissue.

Report the service when the maxillary sinus is entered and diagnostically examined; document the approach, side or sides examined, and relevant findings. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral reporting, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

How Puerto Rico compares for 31233

Across 109 of 109 payment localities, the office rate for 31233 runs from $240.71 in Arkansas to $360.32 in San Benito County, CA. Puerto Rico pays $274.51. The RVUs are the same everywhere; the geographic indexes change the dollars.

31233 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$274.51
  2. Los Angeles, CA · California$307.13+$32.62
  3. Washington, DC area · District of Columbia$311.59+$37.08
  4. Miami, FL · Florida$295.72+$21.21
  5. Chicago, IL · Illinois$286.98+$12.47
  6. Manhattan, NY · New York$313.98+$39.47
  7. Alaska · Alaska$316.06+$41.55

Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.

Every other payment area

31233 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$244.28$108.38
ArkansasArkansas$240.71$107.29
ArizonaArizona$265.18$114.68
Bakersfield, CACalifornia$288.36$118.13
Chico, CACalifornia$287.48$117.26
El Centro, CACalifornia$287.53$117.31
Fresno, CACalifornia$287.48$117.26
Hanford, CACalifornia$287.48$117.26

31233 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$240.71

$323.90

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
31233 office rate range by state
State / territoryOffice rate rangeLocalities
AK$316.061
AL$244.281
AR$240.711
AZ$265.181
CA$287.48–$360.3229
CO$283.461
CT$290.821
DC$311.591
DE$269.601
FL$269.17–$295.723
GA$253.81–$277.842
GU$294.551
HI$294.551
IA$250.241
ID$251.961
IL$261.54–$286.984
IN$253.431
KS$249.211
KY$250.461
LA$250.12–$262.622
MA$281.80–$311.502
MD$274.74–$311.593
ME$253.45–$267.132
MI$257.19–$272.732
MN$271.051
MO$245.88–$263.383
MS$243.331
MT$272.531
NC$256.111
ND$266.601
NE$251.581
NH$279.151
NJ$293.98–$308.342
NM$258.681
NV$271.071
NY$260.01–$321.865
OH$255.981
OK$249.841
OR$268.81–$292.372
PA$256.31–$283.612
PR$274.511
RI$279.141
SC$256.501
SD$265.901
TN$250.501
TX$254.62–$282.658
UT$260.051
VA$266.35–$311.592
VI$274.511
VT$265.691
WA$281.22–$317.722
WI$257.581
WV$251.801
WY$269.951

See 31233 in every payment locality

How the 31233 rate is calculated

Each of 31233’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 31233

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.13

2.13 RVUs× 1.000 GPCI

Practice expense5.73

5.73 RVUs× 1.000 GPCI

Malpractice0.30

0.30 RVUs× 1.000 GPCI

Adjusted RVUs

8.1600

Conversion factor

$33.4009

Medicare rate

$272.55

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,525

Code
31233
Physician work
2.13
Practice expense
5.73
Malpractice
0.30

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 31233 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.13× 1.0002.1300
Practice expense5.73× 1.0115.7930
Malpractice0.30× 0.9850.2955
Total RVUs8.2185
Conversion factor× 33.4009

Office rate, Puerto Rico$274.51

Office: (2.13 × 1 + 5.73 × 1.011 + 0.3 × 0.985) × $33.4009 = $274.51

Facility: (2.13 × 1 + 1.08 × 1.011 + 0.3 × 0.985) × $33.4009 = $117.48

Open 31233 in the RVU calculator

Payment rules and modifiers for 31233

The CMS indicators that decide how 31233 is paid alongside other services.

CMS payment indicators · 31233

Sinus endoscopy, maxillary sinus

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures3Endoscopy family rules apply.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

31233 without 50 · national office

$272.55

Sinus endoscopy, maxillary sinus

31233-50 · Bilateral: 150%

$408.83

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

Codes related to 31233

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 31233
CodeHow it relatesOffice range, Puerto Rico
Used instead
31231Nasal endoscopy, diagnostic, without sinusoscopyDiagnostic nasal-cavity endoscopy without maxillary sinus examination.$194.99
31256Maxillary antrostomy, without tissue removalOperative maxillary sinus opening without tissue removal, rather than diagnostic sinus inspection.No office rate
31267Sinus endoscopy, maxillary tissue removalOperative maxillary sinus endoscopy that includes tissue removal.No office rate
31237Nasal endoscopy, biopsy, polypectomy, or debridementSurgical endoscopy involving biopsy, polyp removal, or debridement.$268.22
Same family
31235Sinus endoscopy, diagnostic sphenoid sinusoscopyDiagnostic sinus endoscopy directed to the sphenoid sinus.$312.44

How 31233 has changed in Puerto Rico

31233 · Office / nonfacility

$274.51

Effective 2026-10-01

The base rate is $11.41 higher than on 2025-10-01, moving from $263.10 to $274.51 (4.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $263.10changed to$274.51

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.18 changed to 2.13
    • Practice expense RVU 5.62 changed to 5.73
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $275.77changed to$263.10

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 5.75 changed to 5.62
    • Malpractice RVU 0.32 changed to 0.30

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $271.27changed to$275.77

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $282.00changed to$271.27

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 5.80 changed to 5.75
    • Malpractice RVU 0.30 changed to 0.32
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $280.59changed to$282.00

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $286.60changed to$280.59

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 5.75 changed to 5.80
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $280.19changed to$286.60

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.51 changed to 5.75
    • Malpractice RVU 0.30 changed to 0.31

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $270.17changed to$280.19

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.97 changed to 5.51
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $268.18changed to$270.17

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.92 changed to 4.97
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $264.63changed to$268.18

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.84 changed to 4.92
    • Malpractice RVU 0.30 changed to 0.31

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $236.83changed to$264.63

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.93 changed to 4.84
    • Malpractice RVU 0.31 changed to 0.30
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $208.27changed to$236.83

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.03 changed to 4.93
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $208.12changed to$208.27

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.99 changed to 5.03
    • Malpractice RVU 0.32 changed to 0.31

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $207.08changed to$208.12

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $206.74changed to$207.08

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.08 changed to 4.99
    • Malpractice RVU 0.28 changed to 0.32
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $206.73changed to$206.74

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.64 changed to 5.08
    • Malpractice RVU 0.29 changed to 0.28
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $206.73

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$274.51$117.48RVU26D
2026-07-01$274.51$117.48RVU26C
2026-04-01$274.51$117.48RVU26B
2026-01-01$274.51$117.48RVU26A
2025-10-01$263.10$131.51RVU25D
2025-07-01$263.10$131.51RVU25C
2025-04-01$263.10$131.51RVU25B
2025-01-01$263.10$131.51RVU25A
2024-10-01$275.77$135.32RVU24D
2024-07-01$275.77$135.32RVU24C
2024-04-01$275.77$135.32RVU24B
2024-03-09$275.77$135.32RVU24AR
2024-01-01$271.27$133.11RVU24A
2023-10-01$282.00$136.48RVU23D
2023-07-01$280.59$136.23RVU23C
2023-04-01$280.59$136.23RVU23B
2023-01-01$280.59$136.23RVU23A
2022-10-01$286.60$137.30RVU22D
2022-07-01$286.60$137.30RVU22C
2022-04-01$286.60$137.30RVU22B
2022-01-01$286.60$137.30RVU22A
2021-10-01$280.19$136.33RVU21D
2021-07-01$280.19$136.33RVU21C
2021-04-01$280.19$136.33RVU21B
2021-01-01$280.19$136.33RVU21A
2020-10-01$270.17$138.85RVU20D
2020-07-01$270.17$138.85RVU20C
2020-04-01$270.17$138.85RVU20B
2020-01-01$270.17$138.85RVU20A
2019-10-01$268.18$139.71RVU19D
2019-07-01$268.18$139.71RVU19C
2019-04-01$268.18$139.71RVU19B
2019-01-01$268.18$139.71RVU19A
2018-10-01$264.63$138.84RVU18D
2018-07-01$264.63$138.84RVU18C
2018-04-01$264.63$138.84RVU18B
2018-01-01$264.63$138.84RVU18AR1
2017-10-01$236.83$129.00RVU17D
2017-07-01$236.83$129.00RVU17C
2017-04-01$236.83$129.00RVU17B
2017-01-01$236.83$129.00RVU17A
2016-10-01$208.27$117.91RVU16D
2016-07-01$208.27$117.91RVU16C
2016-04-01$208.27$117.91RVU16B
2016-01-01$208.27$117.91RVU16A
2015-10-01$208.12$118.18RVU15D
2015-07-01$208.12$118.18RVU15C
2015-04-01$207.08$117.60RVU15B
2015-01-01$207.08$117.60RVU15A
2014-10-01$206.74$117.75RVU14D
2014-07-01$206.74$117.75RVU14C
2014-04-01$206.74$117.75RVU14B
2014-01-01$206.74$117.75RVU14A
2013-10-01$206.73$113.77RVU13D
2013-07-01$206.73$113.77RVU13C
2013-04-01$206.73$113.77RVU13B
2013-01-01$206.73$113.77RVU13AR

Price 31233 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

31233 billing questions

How does this differ from 31231?

31231 describes diagnostic nasal endoscopy limited to the nasal cavity. Use 31233 when the scope is advanced into and used to inspect the maxillary sinus.

How does this differ from 31235?

31235 is the diagnostic endoscopic examination of the sphenoid sinus. Code 31233 is for diagnostic examination of the maxillary sinus.

Can 31233 be reported with another endoscopy code?

Related endoscopies may be performed together, but CMS endoscopy family pricing applies. Document the distinct anatomic sites and services performed.

How is bilateral work reported?

For bilateral performance, report modifier 50; CMS pays 31233 at 150%. Document examination of both maxillary sinuses.

Can 31233 be reported for a maxillary antrostomy?

No. A diagnostic examination through the natural sinus opening is different from operative creation or enlargement of an opening, such as the service represented by 31256.

What documentation supports 31233?

Record that the endoscope entered the maxillary sinus, the side examined, and the diagnostic findings. A note describing nasal-cavity inspection alone supports a different service.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 31233PPRRVU2026_Oct_nonQPP.csv, line 3,525 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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