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CPT code 31238: Nasal endoscopy, hemorrhage control2026 Medicare rate & RVUs in Washington, DC area

Endoscopic surgical treatment of nasal bleeding, reported when the provider uses a nasal endoscope to locate and control a hemorrhage.

CMS RVU26DEffective Oct 1, 2026One payment locality21.5K Medicare services in 2024

In Washington, DC area, Medicare pays $294.60 for 31238 in the office and $158.07 when it’s performed in a hospital or facility.

$294.60Office (non-facility)
$158.07Hospital or facility
+13.2%vs the national office rate ($260.19)

Check a contract rate as a % of Medicare · 31238 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 31238 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 31238 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 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.

How Washington, DC area compares for 31238

Across 109 of 109 payment localities, the office rate for 31238 runs from $231.60 in Arkansas to $333.79 in San Benito County, CA. Washington, DC area pays $294.60. The RVUs are the same everywhere; the geographic indexes change the dollars.

31238 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$294.60
  2. Los Angeles, CA · California$288.38−$6.22
  3. Miami, FL · Florida$286.59−$8.01
  4. Chicago, IL · Illinois$278.48−$16.12
  5. Manhattan, NY · New York$299.13+$4.53
  6. Alaska · Alaska$309.20+$14.60
  7. Alabama · Alabama$234.79−$59.81

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

31238 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$231.60$132.04
ArizonaArizona$253.42$141.11
Bakersfield, CACalifornia$271.96$144.93
Chico, CACalifornia$270.83$143.80
El Centro, CACalifornia$270.90$143.87
Fresno, CACalifornia$270.83$143.80
Hanford, CACalifornia$270.83$143.80
Madera, CACalifornia$270.83$143.80

31238 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.

$231.60

$309.20

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

View every state and territory as a table
31238 office rate range by state
State / territoryOffice rate rangeLocalities
AK$309.201
AL$234.791
AR$231.601
AZ$253.421
CA$270.83–$333.7929
CO$268.521
CT$276.881
DC$294.601
DE$257.431
FL$259.79–$286.593
GA$245.63–$265.612
GU$276.351
HI$276.351
IA$238.911
ID$240.691
IL$253.78–$278.484
IN$241.961
KS$238.571
KY$241.551
LA$241.48–$252.642
MA$267.35–$293.072
MD$261.91–$294.603
ME$242.63–$253.962
MI$248.13–$263.602
MN$255.601
MO$238.05–$252.643
MS$234.831
MT$260.171
NC$244.911
ND$252.461
NE$239.931
NH$265.041
NJ$279.56–$291.972
NM$249.701
NV$258.181
NY$248.42–$306.925
OH$246.551
OK$240.381
OR$255.69–$275.822
PA$246.52–$270.792
PR$261.741
RI$265.691
SC$246.231
SD$251.541
TN$239.791
TX$245.05–$268.058
UT$249.391
VA$253.68–$294.602
VI$261.741
VT$252.181
WA$266.61–$298.132
WI$244.541
WV$245.111
WY$256.811

See 31238 in every payment locality

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

Office or facility?

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.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,528

Code
31238
Physician work
2.67
Practice expense
4.73
Malpractice
0.39

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 31238 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work2.67× 1.0542.8142
Practice expense4.73× 1.1785.5719
Malpractice0.39× 1.1130.4341
Total RVUs8.8202
Conversion factor× 33.4009

Office rate, Washington, DC area$294.60

Office: (2.67 × 1.054 + 4.73 × 1.178 + 0.39 × 1.113) × $33.4009 = $294.60

Facility: (2.67 × 1.054 + 1.26 × 1.178 + 0.39 × 1.113) × $33.4009 = $158.07

Open 31238 in the RVU calculator

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

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

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).

When to use modifier 50

Codes related to 31238

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

Codes related to 31238
CodeHow it relatesOffice range, Washington, DC area
Used instead
31231Nasal endoscopy, diagnostic, without sinusoscopyDiagnostic nasal endoscopy when no surgical hemorrhage control is performed.$223.04
31241Artery ligation, endoscopic epistaxis controlUse for endoscopic ligation of the sphenopalatine artery when that specific operation is performed.No office rate
30903Nosebleed control, complex anterior treatmentNonendoscopic control of complex anterior nasal bleeding.$306.38
30905Nosebleed control, posterior, initial treatmentNonendoscopic control of posterior nasal bleeding.$457.06

How 31238 has changed in Washington, DC area

31238 · Office / nonfacility

$294.60

Effective 2026-10-01

The base rate is $8.82 higher than on 2025-10-01, moving from $285.78 to $294.60 (3.1%).

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

    $285.78changed to$294.60

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.74 changed to 2.67
    • Practice expense RVU 4.60 changed to 4.73
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $286.15changed to$285.78

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.39 changed to 4.60
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $281.48changed to$286.15

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $295.33changed to$281.48

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.41 changed to 4.39
    • Malpractice RVU 0.38 changed to 0.40
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $302.19changed to$295.33

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.32 changed to 4.41
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $301.22changed to$302.19

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.25 changed to 4.32
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $297.06changed to$301.22

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.99 changed to 4.25
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $296.36changed to$297.06

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.04 changed to 3.99
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $306.43changed to$296.36

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 4.29 changed to 4.04
    • Malpractice RVU 0.38 changed to 0.39

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $301.61changed to$306.43

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.18 changed to 4.29
    • Malpractice RVU 0.39 changed to 0.38
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $305.21changed to$301.61

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.27 changed to 4.18
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $304.60changed to$305.21

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.22 changed to 4.27
    • Malpractice RVU 0.40 changed to 0.39

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $303.09changed to$304.60

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $300.31changed to$303.09

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.25 changed to 4.22
    • Malpractice RVU 0.33 changed to 0.40
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $394.20changed to$300.31

    • Conversion factor 34.0230 changed to 35.8228
    • Work RVU 3.26 changed to 2.74
    • Practice expense RVU 6.43 changed to 4.25
    • Malpractice RVU 0.41 changed to 0.33
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $394.20

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$294.60$158.07RVU26D
2026-07-01$294.60$158.07RVU26C
2026-04-01$294.60$158.07RVU26B
2026-01-01$294.60$158.07RVU26A
2025-10-01$285.78$181.67RVU25D
2025-07-01$285.78$181.67RVU25C
2025-04-01$285.78$181.67RVU25B
2025-01-01$285.78$181.67RVU25A
2024-10-01$286.15$186.16RVU24D
2024-07-01$286.15$186.16RVU24C
2024-04-01$286.15$186.16RVU24B
2024-03-09$286.15$186.16RVU24AR
2024-01-01$281.48$183.12RVU24A
2023-10-01$295.33$190.01RVU23D
2023-07-01$295.33$190.01RVU23C
2023-04-01$295.33$190.01RVU23B
2023-01-01$295.33$190.01RVU23A
2022-10-01$302.19$193.11RVU22D
2022-07-01$302.19$193.11RVU22C
2022-04-01$302.19$193.11RVU22B
2022-01-01$302.19$193.11RVU22A
2021-10-01$301.22$191.68RVU21D
2021-07-01$301.22$191.68RVU21C
2021-04-01$301.22$191.68RVU21B
2021-01-01$301.22$191.68RVU21A
2020-10-01$297.06$193.95RVU20D
2020-07-01$297.06$193.95RVU20C
2020-04-01$297.06$193.95RVU20B
2020-01-01$297.06$193.95RVU20A
2019-10-01$296.36$193.44RVU19D
2019-07-01$296.36$193.44RVU19C
2019-04-01$296.36$193.44RVU19B
2019-01-01$296.36$193.44RVU19A
2018-10-01$306.43$191.90RVU18D
2018-07-01$306.43$191.90RVU18C
2018-04-01$306.43$191.90RVU18B
2018-01-01$306.43$191.90RVU18AR1
2017-10-01$301.61$194.36RVU17D
2017-07-01$301.61$194.36RVU17C
2017-04-01$301.61$194.36RVU17B
2017-01-01$301.61$194.36RVU17A
2016-10-01$305.21$196.48RVU16D
2016-07-01$305.21$196.48RVU16C
2016-04-01$305.21$196.48RVU16B
2016-01-01$305.21$196.48RVU16A
2015-10-01$304.60$196.79RVU15D
2015-07-01$304.60$196.79RVU15C
2015-04-01$303.09$195.81RVU15B
2015-01-01$303.09$195.81RVU15A
2014-10-01$300.31$194.38RVU14D
2014-07-01$300.31$194.38RVU14C
2014-04-01$300.31$194.38RVU14B
2014-01-01$300.31$194.38RVU14A
2013-10-01$394.20$220.15RVU13D
2013-07-01$394.20$220.15RVU13C
2013-04-01$394.20$220.15RVU13B
2013-01-01$394.20$220.15RVU13AR

Price 31238 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

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.

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

Show the CMS file lines behind this rate
RVUs for 31238PPRRVU2026_Oct_nonQPP.csv, line 3,528 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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