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CPT code 31235: Sinus endoscopy, diagnostic sphenoid sinusoscopy2026 Medicare rate & RVUs in Puerto Rico

ENT clinicians report diagnostic sphenoid sinus endoscopy to inspect the sphenoid sinus through the nose when evaluating suspected or known sinus disease.

CMS RVU26DEffective Oct 1, 2026One payment locality385 Medicare services in 2024

In Puerto Rico, Medicare pays $312.44 for 31235 in the office and $138.20 when it’s performed in a hospital or facility.

$312.44Office (non-facility)
$138.20Hospital or facility
+0.7%vs the national office rate ($310.29)

Check a contract rate as a % of Medicare · 31235 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 31235 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 31235 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 31235 covers

An otolaryngologist passes an endoscope through the nasal passage to examine the sphenoid sinus. The diagnostic view can help assess suspected sphenoid sinus inflammation, a lesion, or other findings identified during evaluation of sinus symptoms or imaging. The service is performed in settings such as an ENT office or operating room when the purpose is diagnostic visualization rather than sphenoid sinus surgery.

Report the code when documentation supports examination of the sphenoid sinus, not merely a general nasal examination or visualization of another sinus. If the same session includes related nasal or sinus endoscopies, CMS endoscopy-family pricing applies. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 identifies bilateral performance and CMS pays it 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 31235

Across 109 of 109 payment localities, the office rate for 31235 runs from $274.40 in Arkansas to $407.75 in San Benito County, CA. Puerto Rico pays $312.44. The RVUs are the same everywhere; the geographic indexes change the dollars.

31235 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$312.44
  2. Los Angeles, CA · California$348.47+$36.03
  3. Washington, DC area · District of Columbia$354.08+$41.64
  4. Miami, FL · Florida$337.89+$25.45
  5. Chicago, IL · Illinois$327.96+$15.52
  6. Manhattan, NY · New York$357.39+$44.95
  7. Alaska · Alaska$361.45+$49.01

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

Every other payment area

31235 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$278.42$127.61
ArkansasArkansas$274.40$126.35
ArizonaArizona$301.94$134.93
Bakersfield, CACalifornia$327.45$138.56
Chico, CACalifornia$326.38$137.49
El Centro, CACalifornia$326.44$137.55
Fresno, CACalifornia$326.38$137.49
Hanford, CACalifornia$326.38$137.49

31235 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.

$274.40

$367.07

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

View every state and territory as a table
31235 office rate range by state
State / territoryOffice rate rangeLocalities
AK$361.451
AL$278.421
AR$274.401
AZ$301.941
CA$326.38–$407.7529
CO$322.191
CT$330.941
DC$354.081
DE$306.931
FL$307.18–$337.893
GA$289.76–$316.432
GU$334.151
HI$334.151
IA$284.811
ID$286.811
IL$298.80–$327.964
IN$288.461
KS$283.801
KY$285.701
LA$285.38–$299.462
MA$320.40–$353.602
MD$312.68–$354.083
ME$288.66–$303.832
MI$293.44–$311.352
MN$307.741
MO$280.70–$300.143
MS$277.591
MT$310.271
NC$291.621
ND$302.951
NE$286.281
NH$317.451
NJ$334.44–$350.482
NM$295.171
NV$308.441
NY$296.02–$366.475
OH$291.941
OK$284.841
OR$305.78–$332.052
PA$292.22–$322.922
PR$312.441
RI$317.591
SC$292.321
SD$302.091
TN$285.271
TX$290.33–$321.368
UT$296.311
VA$303.06–$354.082
VI$312.441
VT$302.071
WA$319.70–$360.472
WI$292.831
WV$287.841
WY$307.081

See 31235 in every payment locality

How the 31235 rate is calculated

Each of 31235’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 · 31235

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.57

2.57 RVUs× 1.000 GPCI

Practice expense6.35

6.35 RVUs× 1.000 GPCI

Malpractice0.37

0.37 RVUs× 1.000 GPCI

Adjusted RVUs

9.2900

Conversion factor

$33.4009

Medicare rate

$310.29

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

3,526

Code
31235
Physician work
2.57
Practice expense
6.35
Malpractice
0.37

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 31235 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.57× 1.0002.5700
Practice expense6.35× 1.0116.4198
Malpractice0.37× 0.9850.3644
Total RVUs9.3543
Conversion factor× 33.4009

Office rate, Puerto Rico$312.44

Office: (2.57 × 1 + 6.35 × 1.011 + 0.37 × 0.985) × $33.4009 = $312.44

Facility: (2.57 × 1 + 1.19 × 1.011 + 0.37 × 0.985) × $33.4009 = $138.20

Open 31235 in the RVU calculator

Payment rules and modifiers for 31235

The CMS indicators that decide how 31235 is paid alongside other services.

CMS payment indicators · 31235

Sinus endoscopy, diagnostic sphenoid sinusoscopy

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

31235 without 50 · national office

$310.29

Sinus endoscopy, diagnostic sphenoid sinusoscopy

31235-50 · Bilateral: 150%

$465.44

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 31235

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

Codes related to 31235
CodeHow it relatesOffice range, Puerto Rico
Same family
31231Nasal endoscopy, diagnostic, without sinusoscopyDiagnostic nasal endoscopy without the sphenoid sinus examination included in 31235.$194.99
31233Sinus endoscopy, maxillary sinusDiagnostic sinus endoscopy directed to the maxillary sinus rather than the sphenoid sinus.$274.51
Used instead
31237Nasal endoscopy, biopsy, polypectomy, or debridementUse for qualifying surgical endoscopy with biopsy, polypectomy, or debridement rather than diagnostic visualization alone.$268.22
31287Sphenoidotomy, without tissue removalSurgical sphenoidotomy when the documented service goes beyond diagnostic sphenoid sinusoscopy.No office rate
31288Sphenoid surgery, sphenoid tissue removalSphenoid surgery with tissue removal, rather than diagnostic sphenoid sinusoscopy alone.No office rate

How 31235 has changed in Puerto Rico

31235 · Office / nonfacility

$312.44

Effective 2026-10-01

The base rate is $11.40 higher than on 2025-10-01, moving from $301.04 to $312.44 (3.8%).

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

    $301.04changed to$312.44

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.64 changed to 2.57
    • Practice expense RVU 6.24 changed to 6.35
    • Malpractice RVU 0.39 changed to 0.37
    • 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

    $313.50changed to$301.04

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.37 changed to 6.24
    • Malpractice RVU 0.37 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $308.38changed to$313.50

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $319.07changed to$308.38

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.39 changed to 6.37
    • Malpractice RVU 0.34 changed to 0.37
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $317.52changed to$319.07

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

  6. January 1, 2023

    RVU23A

    $325.17changed to$317.52

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.38 changed to 6.39
    • Malpractice RVU 0.33 changed to 0.34
    • 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

    $318.06changed to$325.17

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.15 changed to 6.38
    • Malpractice RVU 0.28 changed to 0.33

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $307.86changed to$318.06

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.53 changed to 6.15
    • Malpractice RVU 0.32 changed to 0.28
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $306.51changed to$307.86

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.48 changed to 5.53
    • Malpractice RVU 0.35 changed to 0.32
    • 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

    $302.91changed to$306.51

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.39 changed to 5.48

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $271.08changed to$302.91

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.47 changed to 5.39
    • Malpractice RVU 0.36 changed to 0.35
    • 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

    $238.75changed to$271.08

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 5.56 changed to 5.47
    • Malpractice RVU 0.37 changed to 0.36
    • 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

    $238.60changed to$238.75

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 5.52 changed to 5.56

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $237.41changed to$238.60

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $236.25changed to$237.41

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 5.59 changed to 5.52
    • Malpractice RVU 0.32 changed to 0.37
    • 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

    $235.87changed to$236.25

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 6.21 changed to 5.59
    • Malpractice RVU 0.33 changed to 0.32
    • 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: $235.87

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$312.44$138.20RVU26D
2026-07-01$312.44$138.20RVU26C
2026-04-01$312.44$138.20RVU26B
2026-01-01$312.44$138.20RVU26A
2025-10-01$301.04$156.41RVU25D
2025-07-01$301.04$156.41RVU25C
2025-04-01$301.04$156.41RVU25B
2025-01-01$301.04$156.41RVU25A
2024-10-01$313.50$159.30RVU24D
2024-07-01$313.50$159.30RVU24C
2024-04-01$313.50$159.30RVU24B
2024-03-09$313.50$159.30RVU24AR
2024-01-01$308.38$156.70RVU24A
2023-10-01$319.07$160.58RVU23D
2023-07-01$317.52$160.29RVU23C
2023-04-01$317.52$160.29RVU23B
2023-01-01$317.52$160.29RVU23A
2022-10-01$325.17$161.22RVU22D
2022-07-01$325.17$161.22RVU22C
2022-04-01$325.17$161.22RVU22B
2022-01-01$325.17$161.22RVU22A
2021-10-01$318.06$159.43RVU21D
2021-07-01$318.06$159.43RVU21C
2021-04-01$318.06$159.43RVU21B
2021-01-01$318.06$159.43RVU21A
2020-10-01$307.86$164.16RVU20D
2020-07-01$307.86$164.16RVU20C
2020-04-01$307.86$164.16RVU20B
2020-01-01$307.86$164.16RVU20A
2019-10-01$306.51$165.33RVU19D
2019-07-01$306.51$165.33RVU19C
2019-04-01$306.51$165.33RVU19B
2019-01-01$306.51$165.33RVU19A
2018-10-01$302.91$164.79RVU18D
2018-07-01$302.91$164.79RVU18C
2018-04-01$302.91$164.79RVU18B
2018-01-01$302.91$164.79RVU18AR1
2017-10-01$271.08$152.81RVU17D
2017-07-01$271.08$152.81RVU17C
2017-04-01$271.08$152.81RVU17B
2017-01-01$271.08$152.81RVU17A
2016-10-01$238.75$140.31RVU16D
2016-07-01$238.75$140.31RVU16C
2016-04-01$238.75$140.31RVU16B
2016-01-01$238.75$140.31RVU16A
2015-10-01$238.60$140.56RVU15D
2015-07-01$238.60$140.56RVU15C
2015-04-01$237.41$139.86RVU15B
2015-01-01$237.41$139.86RVU15A
2014-10-01$236.25$139.82RVU14D
2014-07-01$236.25$139.82RVU14C
2014-04-01$236.25$139.82RVU14B
2014-01-01$236.25$139.82RVU14A
2013-10-01$235.87$134.83RVU13D
2013-07-01$235.87$134.83RVU13C
2013-04-01$235.87$134.83RVU13B
2013-01-01$235.87$134.83RVU13AR

Price 31235 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

31235 billing questions

How does this differ from diagnostic nasal endoscopy, 31231?

31235 includes diagnostic examination of the sphenoid sinus. Use 31231 for a diagnostic nasal examination that does not include sphenoid sinusoscopy.

How does this differ from diagnostic maxillary sinus endoscopy, 31233?

The distinction is the sinus examined: 31235 documents sphenoid sinusoscopy, while 31233 addresses maxillary sinusoscopy.

Can diagnostic sphenoid endoscopy be separately reported with sphenoid surgery?

When the same session proceeds to sphenoid surgery, compare the documented operative service with the surgical code, such as 31287 or 31288. Do not assume the diagnostic examination is separately reportable.

What modifier identifies bilateral performance?

Use modifier 50 for bilateral performance; CMS pays this procedure at 150% when reported bilaterally.

What documentation supports reporting 31235?

Document that the endoscope was used to examine the sphenoid sinus and record the diagnostic findings. A note describing only general nasal inspection does not establish sphenoid sinusoscopy.

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 31235PPRRVU2026_Oct_nonQPP.csv, line 3,526 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

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