CPT code 31238: Nasal endoscopy, hemorrhage control2026 Medicare rate & RVUs in California
Endoscopic surgical treatment of nasal bleeding, reported when the provider uses a nasal endoscope to locate and control a hemorrhage.
Medicare pays $270.83–$333.79 for 31238 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 31238 covers
An otolaryngologist typically uses a nasal endoscope to find and treat a bleeding site, often when epistaxis persists despite packing or other initial measures. The surgeon may cauterize or otherwise surgically control the source. The procedure is commonly performed in an operating room or procedure setting, with anesthesia as clinically appropriate.
Report this code when the documented service is endoscopic surgical control of nasal bleeding, rather than diagnostic inspection alone or control performed without endoscopy. The record should describe the bleeding site, side, operative method, and reason for intervention. This minor procedure 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. Modifier 50 identifies bilateral services and is paid at 150%. An assistant is paid only when medical necessity is documented; 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.
Where 31238 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$270.83 to $333.79
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $271.96 | $144.93 |
| Chico, CA | $270.83 | $143.80 |
| El Centro, CA | $270.90 | $143.87 |
| Fresno, CA | $270.83 | $143.80 |
| Hanford, CA | $270.83 | $143.80 |
| Los Angeles, CA | $288.38 | $151.27 |
| Madera, CA | $270.83 | $143.80 |
| Marin County, CA | $326.39 | $162.97 |
| Merced, CA | $270.83 | $143.80 |
| Modesto, CA | $270.83 | $143.80 |
| Napa, CA | $309.64 | $156.88 |
| Oxnard, CA | $286.53 | $149.54 |
| Redding, CA | $270.83 | $143.80 |
| Rest of California | $270.83 | $143.80 |
| Riverside, CA | $275.05 | $148.02 |
| Sacramento, CA | $283.11 | $148.32 |
| Salinas, CA | $282.03 | $147.70 |
| San Benito County, CA | $333.79 | $166.66 |
| San Diego, CA | $287.87 | $149.25 |
| San Francisco, CA | $325.95 | $162.53 |
| San Luis Obispo, CA | $277.62 | $145.61 |
| Santa Clara County, CA | $331.98 | $164.85 |
| Santa Cruz, CA | $289.99 | $149.17 |
| Santa Maria, CA | $282.87 | $147.73 |
| Santa Rosa, CA | $292.85 | $150.52 |
| Stockton, CA | $270.83 | $143.80 |
| Vallejo, CA | $309.00 | $156.25 |
| Visalia, CA | $270.83 | $143.80 |
| Yuba City, CA | $270.83 | $143.80 |
How the 31238 rate is calculated
Each of 31238’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 · 31238
RVUs × geographic indexes × conversion factor
Work2.67
2.67 RVUs× 1.000 GPCI
Practice expense4.73
4.73 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
7.7900
Conversion factor
$33.4009
Medicare rate
$260.19
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31238
The CMS indicators that decide how 31238 is paid alongside other services.
CMS payment indicators · 31238
Nasal endoscopy, hemorrhage control
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
31238 without 50 · national office
$260.19
Nasal endoscopy, hemorrhage control
31238-50 · Bilateral: 150%
$390.29
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).
31238 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31231Nasal endoscopyDiagnostic, without sinusoscopy
- 31231 is diagnostic nasal endoscopy. Choose 31238 when the endoscopic encounter includes surgical treatment of nasal hemorrhage.
- 31241Artery ligationEndoscopic epistaxis control
- 31241 identifies endoscopic ligation of the sphenopalatine artery. Use it when that specific operation is performed, rather than reporting general endoscopic hemorrhage control.
- 30903Nosebleed controlComplex anterior treatment
- 30903 describes complex anterior nasal bleeding control without the endoscopic surgical approach represented by 31238.
- 30905Nosebleed controlPosterior, initial treatment
- 30905 describes nonendoscopic control of posterior nasal bleeding; 31238 requires endoscopic surgical control.
31238 billing questions
When should 31238 be chosen instead of a diagnostic nasal endoscopy?
Use 31238 when the endoscopic service includes surgical control of nasal bleeding. A diagnostic examination without operative hemorrhage control is described by 31231.
How does 31238 differ from nasal packing or cautery codes?
31238 describes surgical hemorrhage control performed endoscopically. Codes such as 30903 or 30905 describe nonendoscopic control in the applicable anterior or posterior bleeding situation.
When is modifier 50 appropriate?
Use modifier 50 when the procedure is performed bilaterally. CMS pays the bilateral procedure at 150%.
Can 31231 be reported separately for the operative examination?
A diagnostic look that is part of the endoscopic surgical control is not a separate diagnostic service. Report 31231 only when a distinct diagnostic examination is performed and documented.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.
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.
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