CPT code 31253: Sinus endoscopy, total ethmoidectomy and frontal exploration2026 Medicare rate & RVUs in California
Report this endoscopic sinus operation when the surgeon performs a total ethmoidectomy and explores the frontal sinus during the same procedure.
CMS doesn’t publish an office rate for 31253 in California.
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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What 31253 covers
An otolaryngologist uses an endoscope through the nostril to remove ethmoid air cells as a total ethmoidectomy and access the frontal sinus. Frontal sinus tissue may also be removed when encountered. The operation is used for conditions such as chronic rhinosinusitis with obstructed frontal drainage or nasal polyps, and is typically performed in an operating room.
Select 31253 when the operative report supports both the total ethmoidectomy and frontal sinus exploration; document the work performed on each side. CMS applies endoscopy-family pricing when related endoscopies are performed together. For bilateral reporting, modifier 50 is paid at 150%. The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service; 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 31253 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 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $416.96 |
| Chico, CA | Unavailable | $413.22 |
| El Centro, CA | Unavailable | $413.44 |
| Fresno, CA | Unavailable | $413.22 |
| Hanford, CA | Unavailable | $413.22 |
| Los Angeles, CA | Unavailable | $433.07 |
| Madera, CA | Unavailable | $413.22 |
| Marin County, CA | Unavailable | $459.11 |
| Merced, CA | Unavailable | $413.22 |
| Modesto, CA | Unavailable | $413.22 |
| Napa, CA | Unavailable | $444.12 |
| Oxnard, CA | Unavailable | $427.41 |
| Redding, CA | Unavailable | $413.22 |
| Rest of California | Unavailable | $413.22 |
| Riverside, CA | Unavailable | $427.18 |
| Sacramento, CA | Unavailable | $424.41 |
| Salinas, CA | Unavailable | $422.61 |
| San Benito County, CA | Unavailable | $469.51 |
| San Diego, CA | Unavailable | $425.68 |
| San Francisco, CA | Unavailable | $457.64 |
| San Luis Obispo, CA | Unavailable | $416.83 |
| Santa Clara County, CA | Unavailable | $463.52 |
| Santa Cruz, CA | Unavailable | $424.37 |
| Santa Maria, CA | Unavailable | $422.32 |
| Santa Rosa, CA | Unavailable | $428.10 |
| Stockton, CA | Unavailable | $413.22 |
| Vallejo, CA | Unavailable | $442.01 |
| Visalia, CA | Unavailable | $413.22 |
| Yuba City, CA | Unavailable | $413.22 |
How the 31253 rate is calculated
Each of 31253’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 · 31253
RVUs × geographic indexes × conversion factor
Work8.78
8.78 RVUs× 1.000 GPCI
Practice expense2.51
2.51 RVUs× 1.000 GPCI
Malpractice1.29
1.29 RVUs× 1.000 GPCI
Adjusted RVUs
12.5800
Conversion factor
$33.4009
Medicare rate
$420.18
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31253
The CMS indicators that decide how 31253 is paid alongside other services.
CMS payment indicators · 31253
Sinus endoscopy, total ethmoidectomy and frontal exploration
| 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) | 1 | Not paid (statutory restriction). |
| 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
31253 without 50 · national facility
$420.18
Sinus endoscopy, total ethmoidectomy and frontal exploration
31253-50 · Bilateral: 150%
$630.27
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).
31253 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31255EthmoidectomyTotal, anterior and posterior cells
- 31255 describes total ethmoidectomy alone. Choose 31253 when the surgeon also explores the frontal sinus in the same operative service.
- 31276Frontal sinus endoscopyTissue removal when performed
- 31276 describes frontal sinus exploration without the total ethmoidectomy. When both procedures are performed, 31253 describes their combination.
- 31257Sinus endoscopyTotal ethmoidectomy and sphenoidotomy
- 31257 combines total ethmoidectomy with sphenoidotomy. 31253 pairs total ethmoidectomy with frontal sinus exploration instead.
- 31254EthmoidectomyPartial, anterior ethmoid
- 31254 represents partial ethmoidectomy. 31253 requires total ethmoidectomy and also includes frontal sinus exploration.
31253 billing questions
When should 31253 be chosen instead of 31255?
Use 31253 when the surgeon performs a total ethmoidectomy and frontal sinus exploration. Code 31255 describes a total ethmoidectomy without the frontal sinus work.
Can 31255 or 31276 also be reported for the same operative work?
Do not separately report those codes for the total ethmoidectomy or frontal exploration already represented by 31253. CMS endoscopy-family pricing applies when related endoscopies are performed together.
How is bilateral 31253 reported?
Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%. Document the work performed on both sides.
Does 31253 have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Can an assistant surgeon or co-surgeon be paid for 31253?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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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