CPT code 31254: Ethmoidectomy, partial, anterior ethmoid2026 Medicare rate & RVUs
Reports endoscopic removal of part of the anterior ethmoid air cells during surgery for ethmoid sinus disease, rather than complete ethmoidectomy.
Medicare pays $436.55 for 31254 nationally in the office and $205.75 in a hospital or facility. Local office rates run $387.69–$565.22.
Medicare rate · 31254
Ethmoidectomy, partial, anterior ethmoid
- Work RVUs
- 4.16
- Total RVUs
- 13.07
- Global days
- 000
National rate · 2026
$436.55
Office setting, before claim adjustments.
See every locality for 31254 →Billed by an NP, PA or therapist? →
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 10 sections
What 31254 covers
An otolaryngologist uses a nasal endoscope and surgical instruments to remove part of the ethmoid air cells, typically the anterior portion, to treat disease such as chronic inflammation or obstructed drainage. The procedure is commonly performed in a hospital outpatient department or ambulatory surgery center. The extent is partial: complete ethmoid cell removal belongs to a different code. The operative report should identify the treated side, the ethmoid work performed, and the extent of tissue or partitions removed.
Report this code when the surgeon performs partial endoscopic ethmoidectomy, not for diagnostic nasal inspection alone. When related nasal or sinus endoscopies are performed together, CMS endoscopy-family pricing applies. For bilateral surgery, 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 31254 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$387.69 to $565.22
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $393.16 | $191.21 |
| Alaska | $515.07 | $269.26 |
| Arizona | $425.06 | $201.41 |
| Arkansas | $387.69 | $189.44 |
| Atlanta, GA | $445.44 | $210.94 |
| Austin, TX | $450.64 | $206.45 |
| Bakersfield, CA | $458.00 | $205.04 |
| Baltimore area, MD | $463.78 | $216.14 |
| Beaumont, TX | $410.15 | $200.12 |
| Brazoria, TX | $430.75 | $202.03 |
| Chicago, IL | $464.86 | $232.91 |
| Chico, CA | $456.26 | $203.30 |
| Colorado | $451.59 | $206.02 |
| Connecticut | $464.91 | $216.34 |
| Dallas, TX | $433.84 | $203.97 |
| Delaware | $431.89 | $203.86 |
| Detroit, MI | $440.58 | $217.86 |
| East St. Louis, IL | $434.67 | $222.33 |
| El Centro, CA | $456.36 | $203.40 |
| Fort Lauderdale, FL | $456.35 | $222.55 |
| Fort Worth, TX | $431.33 | $203.76 |
| Fresno, CA | $456.26 | $203.30 |
| Galveston, TX | $432.27 | $203.09 |
| Hanford, CA | $456.26 | $203.30 |
| Hawaii, Guam, HI | $466.14 | $203.72 |
| Houston, TX | $443.25 | $214.07 |
| Idaho | $403.78 | $191.45 |
| Indiana | $405.99 | $192.04 |
| Iowa | $400.87 | $189.69 |
| Kansas | $399.96 | $191.32 |
| Kentucky | $404.04 | $198.86 |
| King County, WA | $502.84 | $219.64 |
| Los Angeles, CA | $486.31 | $213.27 |
| Madera, CA | $456.26 | $203.30 |
| Manhattan, NY | $502.15 | $233.96 |
| Marin County, CA | $552.71 | $227.28 |
| Merced, CA | $456.26 | $203.30 |
| Metropolitan Boston, MA | $493.89 | $218.31 |
| Metropolitan Kansas City, MO | $419.16 | $202.44 |
| Metropolitan Philadelphia, PA | $454.30 | $214.04 |
| Metropolitan St. Louis, MO | $423.27 | $203.55 |
| Miami, FL | $478.57 | $238.31 |
| Minnesota | $430.49 | $193.00 |
| Mississippi | $392.74 | $194.02 |
| Modesto, CA | $456.26 | $203.30 |
| Montana | $436.51 | $205.71 |
| Napa, CA | $523.71 | $219.51 |
| Nebraska | $402.71 | $189.68 |
| Nevada | $433.48 | $202.45 |
| New Hampshire | $445.42 | $205.16 |
| New Mexico | $417.54 | $205.90 |
| New Orleans, LA | $422.90 | $205.72 |
| North Carolina | $410.72 | $195.38 |
| North Dakota | $424.65 | $193.85 |
| Northern New Jersey | $491.08 | $223.35 |
| NYC suburbs and Long Island, NY | $515.08 | $240.65 |
| Ohio | $412.56 | $201.84 |
| Oklahoma | $402.38 | $196.28 |
| Oxnard, CA | $483.40 | $210.60 |
| Portland, OR | $464.45 | $208.03 |
| Poughkeepsie and northern NYC suburbs, NY | $473.38 | $220.65 |
| Puerto Rico | $439.30 | $205.96 |
| Queens, NY | $504.82 | $232.01 |
| Redding, CA | $456.26 | $203.30 |
| Rest of California | $456.26 | $203.30 |
| Rest of Florida | $434.42 | $213.77 |
| Rest of Georgia | $410.42 | $204.55 |
| Rest of Illinois | $423.68 | $212.96 |
| Rest of Louisiana | $403.79 | $199.53 |
| Rest of Maine | $406.77 | $194.43 |
| Rest of Maryland | $439.63 | $206.06 |
| Rest of Massachusetts | $449.42 | $206.38 |
| Rest of Michigan | $414.99 | $204.27 |
| Rest of Missouri | $397.73 | $198.78 |
| Rest of New Jersey | $469.59 | $217.55 |
| Rest of New York | $416.72 | $197.46 |
| Rest of Oregon | $429.49 | $199.61 |
| Rest of Pennsylvania | $412.69 | $200.81 |
| Rest of Texas | $420.45 | $201.42 |
| Rest of Washington | $448.28 | $205.24 |
| Rhode Island | $446.18 | $207.77 |
| Riverside, CA | $462.75 | $209.79 |
| Sacramento, CA | $477.50 | $209.07 |
| Salinas, CA | $475.69 | $208.19 |
| San Benito County, CA | $565.22 | $232.40 |
| San Diego, CA | $485.94 | $209.90 |
| San Francisco, CA | $552.03 | $226.60 |
| San Luis Obispo, CA | $468.19 | $205.31 |
| Santa Clara County, CA | $562.43 | $229.62 |
| Santa Cruz, CA | $489.84 | $209.42 |
| Santa Maria, CA | $477.22 | $208.10 |
| Santa Rosa, CA | $494.70 | $211.28 |
| South Carolina | $412.45 | $199.19 |
| South Dakota | $423.24 | $192.44 |
| Southern Maine, ME | $426.66 | $197.93 |
| Stockton, CA | $456.26 | $203.30 |
| Suburban Chicago, IL | $460.49 | $223.46 |
| Tennessee | $402.01 | $192.22 |
| Utah | $417.85 | $200.90 |
| Vallejo, CA | $522.73 | $218.53 |
| Vermont | $423.87 | $195.38 |
| Virgin Islands, VI | $439.30 | $205.96 |
| Virginia | $425.94 | $199.06 |
| Visalia, CA | $456.26 | $203.30 |
| Washington, DC area | $495.72 | $223.84 |
| West Virginia | $408.83 | $208.26 |
| Wisconsin | $411.02 | $189.92 |
| Wyoming | $431.34 | $200.54 |
| Yuba City, CA | $456.26 | $203.30 |
31254 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.
$387.69
$515.07
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 | $515.07 | 1 |
| AL | $393.16 | 1 |
| AR | $387.69 | 1 |
| AZ | $425.06 | 1 |
| CA | $456.26–$565.22 | 29 |
| CO | $451.59 | 1 |
| CT | $464.91 | 1 |
| DC | $495.72 | 1 |
| DE | $431.89 | 1 |
| FL | $434.42–$478.57 | 3 |
| GA | $410.42–$445.44 | 2 |
| GU | $466.14 | 1 |
| HI | $466.14 | 1 |
| IA | $400.87 | 1 |
| ID | $403.78 | 1 |
| IL | $423.68–$464.86 | 4 |
| IN | $405.99 | 1 |
| KS | $399.96 | 1 |
| KY | $404.04 | 1 |
| LA | $403.79–$422.90 | 2 |
| MA | $449.42–$493.89 | 2 |
| MD | $439.63–$495.72 | 3 |
| ME | $406.77–$426.66 | 2 |
| MI | $414.99–$440.58 | 2 |
| MN | $430.49 | 1 |
| MO | $397.73–$423.27 | 3 |
| MS | $392.74 | 1 |
| MT | $436.51 | 1 |
| NC | $410.72 | 1 |
| ND | $424.65 | 1 |
| NE | $402.71 | 1 |
| NH | $445.42 | 1 |
| NJ | $469.59–$491.08 | 2 |
| NM | $417.54 | 1 |
| NV | $433.48 | 1 |
| NY | $416.72–$515.08 | 5 |
| OH | $412.56 | 1 |
| OK | $402.38 | 1 |
| OR | $429.49–$464.45 | 2 |
| PA | $412.69–$454.30 | 2 |
| PR | $439.30 | 1 |
| RI | $446.18 | 1 |
| SC | $412.45 | 1 |
| SD | $423.24 | 1 |
| TN | $402.01 | 1 |
| TX | $410.15–$450.64 | 8 |
| UT | $417.85 | 1 |
| VA | $425.94–$495.72 | 2 |
| VI | $439.30 | 1 |
| VT | $423.87 | 1 |
| WA | $448.28–$502.84 | 2 |
| WI | $411.02 | 1 |
| WV | $408.83 | 1 |
| WY | $431.34 | 1 |
How the 31254 rate is calculated
Each of 31254’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 · 31254
RVUs × geographic indexes × conversion factor
Work4.16
4.16 RVUs× 1.000 GPCI
Practice expense8.31
8.31 RVUs× 1.000 GPCI
Malpractice0.60
0.60 RVUs× 1.000 GPCI
Adjusted RVUs
13.0700
Conversion factor
$33.4009
Medicare rate
$436.55
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31254
The CMS indicators that decide how 31254 is paid alongside other services.
CMS payment indicators · 31254
Ethmoidectomy, partial, anterior ethmoid
| 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
31254 without 50 · national office
$436.55
Ethmoidectomy, partial, anterior ethmoid
31254-50 · Bilateral: 150%
$654.83
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).
31254 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31255EthmoidectomyTotal, anterior and posterior cells
- 31254 is for partial ethmoidectomy, generally anterior. 31255 is for total ethmoidectomy.
- 31253Sinus endoscopyTotal ethmoidectomy and frontal exploration
- 31253 describes total ethmoidectomy combined with frontal sinus surgery; 31254 is partial ethmoidectomy without that combined service.
- 31231Nasal endoscopyDiagnostic, without sinusoscopy
- 31231 is diagnostic nasal endoscopy. It does not represent surgical removal of ethmoid cells.
- 31256Maxillary antrostomyWithout tissue removal
- 31256 reports endoscopic maxillary sinus exploration, not ethmoidectomy. Select based on the sinus actually treated.
31254 billing questions
How does this differ from 31255?
31254 describes partial ethmoidectomy, generally involving the anterior ethmoid cells. Use 31255 when the surgeon performs total ethmoidectomy.
Can this be reported with maxillary or frontal sinus surgery?
A surgeon may perform separately indicated work in other sinuses during the same operation. CMS endoscopy-family pricing applies when related endoscopies are performed together.
How is bilateral surgery reported?
Report bilateral surgery with modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports the partial ethmoidectomy?
The operative report should describe the endoscopic ethmoid work, identify the side, and make clear that the removal was partial rather than total.
Can an assistant surgeon or co-surgeon be billed?
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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