CPT code 31238: Nasal endoscopy, hemorrhage control2026 Medicare rate & RVUs in Montana
Endoscopic surgical treatment of nasal bleeding, reported when the provider uses a nasal endoscope to locate and control a hemorrhage.
In Montana, Medicare pays $260.17 for 31238 in the office and $144.27 when it’s performed in a hospital or facility.
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.
On this page 11 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.
How Montana 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. Montana pays $260.17. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$260.17
- Los Angeles, CA · California$288.38+$28.21
- Washington, DC area · District of Columbia$294.60+$34.43
- Miami, FL · Florida$286.59+$26.42
- Chicago, IL · Illinois$278.48+$18.31
- Manhattan, NY · New York$299.13+$38.96
- Alaska · Alaska$309.20+$49.03
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $234.79 | $133.38 |
| 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 |
| Merced, CACalifornia | $270.83 | $143.80 |
| Modesto, CACalifornia | $270.83 | $143.80 |
| Napa, CACalifornia | $309.64 | $156.88 |
| Oxnard, CACalifornia | $286.53 | $149.54 |
| Redding, CACalifornia | $270.83 | $143.80 |
| Rest of CaliforniaCalifornia | $270.83 | $143.80 |
| Riverside, CACalifornia | $275.05 | $148.02 |
| Sacramento, CACalifornia | $283.11 | $148.32 |
| Salinas, CACalifornia | $282.03 | $147.70 |
| San Diego, CACalifornia | $287.87 | $149.25 |
| Marin County, CACalifornia | $326.39 | $162.97 |
| San Francisco, CACalifornia | $325.95 | $162.53 |
| San Benito County, CACalifornia | $333.79 | $166.66 |
| Santa Clara County, CACalifornia | $331.98 | $164.85 |
| San Luis Obispo, CACalifornia | $277.62 | $145.61 |
| Santa Cruz, CACalifornia | $289.99 | $149.17 |
| Santa Maria, CACalifornia | $282.87 | $147.73 |
| Santa Rosa, CACalifornia | $292.85 | $150.52 |
| Stockton, CACalifornia | $270.83 | $143.80 |
| Vallejo, CACalifornia | $309.00 | $156.25 |
| Visalia, CACalifornia | $270.83 | $143.80 |
| Yuba City, CACalifornia | $270.83 | $143.80 |
| ColoradoColorado | $268.52 | $145.20 |
| ConnecticutConnecticut | $276.88 | $152.05 |
| DelawareDelaware | $257.43 | $142.92 |
| Fort Lauderdale, FLFlorida | $272.77 | $155.36 |
| Rest of FloridaFlorida | $259.79 | $148.99 |
| Atlanta, GAGeorgia | $265.61 | $147.85 |
| Rest of GeorgiaGeorgia | $245.63 | $142.25 |
| Hawaii, Guam, HIHawaii | $276.35 | $144.57 |
| IowaIowa | $238.91 | $132.86 |
| IdahoIdaho | $240.69 | $134.06 |
| East St. Louis, ILIllinois | $260.76 | $154.13 |
| Rest of IllinoisIllinois | $253.78 | $147.96 |
| Suburban Chicago, ILIllinois | $275.14 | $156.11 |
| IndianaIndiana | $241.96 | $134.52 |
| KansasKansas | $238.57 | $133.79 |
| KentuckyKentucky | $241.55 | $138.51 |
| New Orleans, LALouisiana | $252.64 | $143.58 |
| Rest of LouisianaLouisiana | $241.48 | $138.90 |
| Metropolitan Boston, MAMassachusetts | $293.07 | $154.68 |
| Rest of MassachusettsMassachusetts | $267.35 | $145.30 |
| Baltimore area, MDMaryland | $276.24 | $151.88 |
| Rest of MarylandMaryland | $261.91 | $144.62 |
| Rest of MaineMaine | $242.63 | $136.00 |
| Southern Maine, MEMaine | $253.96 | $139.11 |
| Detroit, MIMichigan | $263.60 | $151.75 |
| Rest of MichiganMichigan | $248.13 | $142.31 |
| MinnesotaMinnesota | $255.60 | $136.34 |
| Metropolitan Kansas City, MOMissouri | $250.26 | $141.43 |
| Metropolitan St. Louis, MOMissouri | $252.64 | $142.30 |
| Rest of MissouriMissouri | $238.05 | $138.15 |
| MississippiMississippi | $234.83 | $135.04 |
| North CarolinaNorth Carolina | $244.91 | $136.77 |
| North DakotaNorth Dakota | $252.46 | $136.55 |
| NebraskaNebraska | $239.93 | $132.95 |
| New HampshireNew Hampshire | $265.04 | $144.39 |
| Northern New JerseyNew Jersey | $291.97 | $157.53 |
| Rest of New JerseyNew Jersey | $279.56 | $152.99 |
| New MexicoNew Mexico | $249.70 | $143.42 |
| NevadaNevada | $258.18 | $142.16 |
| NYC suburbs and Long Island, NYNew York | $306.92 | $169.12 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $281.95 | $155.04 |
| Queens, NYNew York | $300.41 | $163.42 |
| Rest of New YorkNew York | $248.42 | $138.32 |
| OhioOhio | $246.55 | $140.73 |
| OklahomaOklahoma | $240.38 | $136.88 |
| Portland, OROregon | $275.82 | $147.06 |
| Rest of OregonOregon | $255.69 | $140.25 |
| Metropolitan Philadelphia, PAPennsylvania | $270.79 | $150.14 |
| Rest of PennsylvaniaPennsylvania | $246.52 | $140.12 |
| Puerto RicoPuerto Rico | $261.74 | $144.56 |
| Rhode IslandRhode Island | $265.69 | $145.97 |
| South CarolinaSouth Carolina | $246.23 | $139.14 |
| South DakotaSouth Dakota | $251.54 | $135.64 |
| TennesseeTennessee | $239.79 | $134.43 |
| Austin, TXTexas | $268.05 | $145.43 |
| Beaumont, TXTexas | $245.05 | $139.58 |
| Brazoria, TXTexas | $256.62 | $141.76 |
| Dallas, TXTexas | $258.51 | $143.08 |
| Fort Worth, TXTexas | $257.10 | $142.82 |
| Galveston, TXTexas | $257.56 | $142.47 |
| Houston, TXTexas | $264.70 | $149.61 |
| Rest of TexasTexas | $250.87 | $140.88 |
| UtahUtah | $249.39 | $140.44 |
| VirginiaVirginia | $253.68 | $139.75 |
| Virgin Islands, VIUnited States Virgin Islands | $261.74 | $144.56 |
| VermontVermont | $252.18 | $137.44 |
| Rest of WashingtonWashington | $266.61 | $144.57 |
| King County, WAWashington | $298.13 | $155.92 |
| WisconsinWisconsin | $244.54 | $133.51 |
| West VirginiaWest Virginia | $245.11 | $144.39 |
| WyomingWyoming | $256.81 | $140.91 |
31238 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $309.20 | 1 |
| AL | $234.79 | 1 |
| AR | $231.60 | 1 |
| AZ | $253.42 | 1 |
| CA | $270.83–$333.79 | 29 |
| CO | $268.52 | 1 |
| CT | $276.88 | 1 |
| DC | $294.60 | 1 |
| DE | $257.43 | 1 |
| FL | $259.79–$286.59 | 3 |
| GA | $245.63–$265.61 | 2 |
| GU | $276.35 | 1 |
| HI | $276.35 | 1 |
| IA | $238.91 | 1 |
| ID | $240.69 | 1 |
| IL | $253.78–$278.48 | 4 |
| IN | $241.96 | 1 |
| KS | $238.57 | 1 |
| KY | $241.55 | 1 |
| LA | $241.48–$252.64 | 2 |
| MA | $267.35–$293.07 | 2 |
| MD | $261.91–$294.60 | 3 |
| ME | $242.63–$253.96 | 2 |
| MI | $248.13–$263.60 | 2 |
| MN | $255.60 | 1 |
| MO | $238.05–$252.64 | 3 |
| MS | $234.83 | 1 |
| MT | $260.17 | 1 |
| NC | $244.91 | 1 |
| ND | $252.46 | 1 |
| NE | $239.93 | 1 |
| NH | $265.04 | 1 |
| NJ | $279.56–$291.97 | 2 |
| NM | $249.70 | 1 |
| NV | $258.18 | 1 |
| NY | $248.42–$306.92 | 5 |
| OH | $246.55 | 1 |
| OK | $240.38 | 1 |
| OR | $255.69–$275.82 | 2 |
| PA | $246.52–$270.79 | 2 |
| PR | $261.74 | 1 |
| RI | $265.69 | 1 |
| SC | $246.23 | 1 |
| SD | $251.54 | 1 |
| TN | $239.79 | 1 |
| TX | $245.05–$268.05 | 8 |
| UT | $249.39 | 1 |
| VA | $253.68–$294.60 | 2 |
| VI | $261.74 | 1 |
| VT | $252.18 | 1 |
| WA | $266.61–$298.13 | 2 |
| WI | $244.54 | 1 |
| WV | $245.11 | 1 |
| WY | $256.81 | 1 |
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.
The exact Montana 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
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.67 | × 1.000 | 2.6700 |
| Practice expense | 4.73 | × 1.000 | 4.7300 |
| Malpractice | 0.39 | × 0.998 | 0.3892 |
| Total RVUs | 7.7892 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$260.17
Office: (2.67 × 1 + 4.73 × 1 + 0.39 × 0.998) × $33.4009 = $260.17
Facility: (2.67 × 1 + 1.26 × 1 + 0.39 × 0.998) × $33.4009 = $144.27
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).
How 31238 has changed in Montana
31238 · Office / nonfacility
$260.17
Effective 2026-10-01
The base rate is $10.41 higher than on 2025-10-01, moving from $249.76 to $260.17 (4.2%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$249.76changed to$260.17
- 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
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$250.36changed to$249.76
- 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.
March 9, 2024
RVU24AR
$246.28changed to$250.36
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$254.89changed to$246.28
- 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
January 1, 2023
RVU23A
$257.51changed to$254.89
- 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
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$256.86changed to$257.51
- 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.
January 1, 2021
RVU21A
$260.77changed to$256.86
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 3.99 changed to 4.25
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$267.27changed to$260.77
- 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
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$275.39changed to$267.27
- 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.
January 1, 2018
RVU18AR1
$268.35changed to$275.39
- 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
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$268.11changed to$268.35
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 4.27 changed to 4.18
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$267.72changed to$268.11
- 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.
July 1, 2015
RVU15C
$266.39changed to$267.72
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$264.17changed to$266.39
- 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
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$345.07changed to$264.17
- 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
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $345.07
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $260.17 | $144.27 | RVU26D |
| 2026-07-01 | $260.17 | $144.27 | RVU26C |
| 2026-04-01 | $260.17 | $144.27 | RVU26B |
| 2026-01-01 | $260.17 | $144.27 | RVU26A |
| 2025-10-01 | $249.76 | $162.43 | RVU25D |
| 2025-07-01 | $249.76 | $162.43 | RVU25C |
| 2025-04-01 | $249.76 | $162.43 | RVU25B |
| 2025-01-01 | $249.76 | $162.43 | RVU25A |
| 2024-10-01 | $250.36 | $166.48 | RVU24D |
| 2024-07-01 | $250.36 | $166.48 | RVU24C |
| 2024-04-01 | $250.36 | $166.48 | RVU24B |
| 2024-03-09 | $250.36 | $166.48 | RVU24AR |
| 2024-01-01 | $246.28 | $163.76 | RVU24A |
| 2023-10-01 | $254.89 | $168.14 | RVU23D |
| 2023-07-01 | $254.89 | $168.14 | RVU23C |
| 2023-04-01 | $254.89 | $168.14 | RVU23B |
| 2023-01-01 | $254.89 | $168.14 | RVU23A |
| 2022-10-01 | $257.51 | $169.26 | RVU22D |
| 2022-07-01 | $257.51 | $169.26 | RVU22C |
| 2022-04-01 | $257.51 | $169.26 | RVU22B |
| 2022-01-01 | $257.51 | $169.26 | RVU22A |
| 2021-10-01 | $256.86 | $168.23 | RVU21D |
| 2021-07-01 | $256.86 | $168.23 | RVU21C |
| 2021-04-01 | $256.86 | $168.23 | RVU21B |
| 2021-01-01 | $256.86 | $168.23 | RVU21A |
| 2020-10-01 | $260.77 | $176.32 | RVU20D |
| 2020-07-01 | $260.77 | $176.32 | RVU20C |
| 2020-04-01 | $260.77 | $176.32 | RVU20B |
| 2020-01-01 | $260.77 | $176.32 | RVU20A |
| 2019-10-01 | $267.27 | $181.86 | RVU19D |
| 2019-07-01 | $267.27 | $181.86 | RVU19C |
| 2019-04-01 | $267.27 | $181.86 | RVU19B |
| 2019-01-01 | $267.27 | $181.86 | RVU19A |
| 2018-10-01 | $275.39 | $180.35 | RVU18D |
| 2018-07-01 | $275.39 | $180.35 | RVU18C |
| 2018-04-01 | $275.39 | $180.35 | RVU18B |
| 2018-01-01 | $275.39 | $180.35 | RVU18AR1 |
| 2017-10-01 | $268.35 | $179.35 | RVU17D |
| 2017-07-01 | $268.35 | $179.35 | RVU17C |
| 2017-04-01 | $268.35 | $179.35 | RVU17B |
| 2017-01-01 | $268.35 | $179.35 | RVU17A |
| 2016-10-01 | $268.11 | $177.88 | RVU16D |
| 2016-07-01 | $268.11 | $177.88 | RVU16C |
| 2016-04-01 | $268.11 | $177.88 | RVU16B |
| 2016-01-01 | $268.11 | $177.88 | RVU16A |
| 2015-10-01 | $267.72 | $178.24 | RVU15D |
| 2015-07-01 | $267.72 | $178.24 | RVU15C |
| 2015-04-01 | $266.39 | $177.36 | RVU15B |
| 2015-01-01 | $266.39 | $177.36 | RVU15A |
| 2014-10-01 | $264.17 | $176.05 | RVU14D |
| 2014-07-01 | $264.17 | $176.05 | RVU14C |
| 2014-04-01 | $264.17 | $176.05 | RVU14B |
| 2014-01-01 | $264.17 | $176.05 | RVU14A |
| 2013-10-01 | $345.07 | $199.79 | RVU13D |
| 2013-07-01 | $345.07 | $199.79 | RVU13C |
| 2013-04-01 | $345.07 | $199.79 | RVU13B |
| 2013-01-01 | $345.07 | $199.79 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
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
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