CPT code 31254: Ethmoidectomy, partial, anterior ethmoid2026 Medicare rate & RVUs in Virginia
Reports endoscopic removal of part of the anterior ethmoid air cells during surgery for ethmoid sinus disease, rather than complete ethmoidectomy.
In Virginia, Medicare pays $425.94 for 31254 in the office and $199.06 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 31254 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 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.
How Virginia compares for 31254
Across 109 of 109 payment localities, the office rate for 31254 runs from $387.69 in Arkansas to $565.22 in San Benito County, CA. Virginia pays $425.94. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Virginia · this page$425.94
- Los Angeles, CA · California$486.31+$60.37
- Washington, DC area · District of Columbia$495.72+$69.78
- Miami, FL · Florida$478.57+$52.63
- Chicago, IL · Illinois$464.86+$38.92
- Manhattan, NY · New York$502.15+$76.21
- Alaska · Alaska$515.07+$89.13
Other areas in Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $393.16 | $191.21 |
| ArkansasArkansas | $387.69 | $189.44 |
| ArizonaArizona | $425.06 | $201.41 |
| Bakersfield, CACalifornia | $458.00 | $205.04 |
| Chico, CACalifornia | $456.26 | $203.30 |
| El Centro, CACalifornia | $456.36 | $203.40 |
| Fresno, CACalifornia | $456.26 | $203.30 |
| Hanford, CACalifornia | $456.26 | $203.30 |
| Madera, CACalifornia | $456.26 | $203.30 |
| Merced, CACalifornia | $456.26 | $203.30 |
| Modesto, CACalifornia | $456.26 | $203.30 |
| Napa, CACalifornia | $523.71 | $219.51 |
| Oxnard, CACalifornia | $483.40 | $210.60 |
| Redding, CACalifornia | $456.26 | $203.30 |
| Rest of CaliforniaCalifornia | $456.26 | $203.30 |
| Riverside, CACalifornia | $462.75 | $209.79 |
| Sacramento, CACalifornia | $477.50 | $209.07 |
| Salinas, CACalifornia | $475.69 | $208.19 |
| San Diego, CACalifornia | $485.94 | $209.90 |
| Marin County, CACalifornia | $552.71 | $227.28 |
| San Francisco, CACalifornia | $552.03 | $226.60 |
| San Benito County, CACalifornia | $565.22 | $232.40 |
| Santa Clara County, CACalifornia | $562.43 | $229.62 |
| San Luis Obispo, CACalifornia | $468.19 | $205.31 |
| Santa Cruz, CACalifornia | $489.84 | $209.42 |
| Santa Maria, CACalifornia | $477.22 | $208.10 |
| Santa Rosa, CACalifornia | $494.70 | $211.28 |
| Stockton, CACalifornia | $456.26 | $203.30 |
| Vallejo, CACalifornia | $522.73 | $218.53 |
| Visalia, CACalifornia | $456.26 | $203.30 |
| Yuba City, CACalifornia | $456.26 | $203.30 |
| ColoradoColorado | $451.59 | $206.02 |
| ConnecticutConnecticut | $464.91 | $216.34 |
| DelawareDelaware | $431.89 | $203.86 |
| Fort Lauderdale, FLFlorida | $456.35 | $222.55 |
| Rest of FloridaFlorida | $434.42 | $213.77 |
| Atlanta, GAGeorgia | $445.44 | $210.94 |
| Rest of GeorgiaGeorgia | $410.42 | $204.55 |
| Hawaii, Guam, HIHawaii | $466.14 | $203.72 |
| IowaIowa | $400.87 | $189.69 |
| IdahoIdaho | $403.78 | $191.45 |
| East St. Louis, ILIllinois | $434.67 | $222.33 |
| Rest of IllinoisIllinois | $423.68 | $212.96 |
| Suburban Chicago, ILIllinois | $460.49 | $223.46 |
| IndianaIndiana | $405.99 | $192.04 |
| KansasKansas | $399.96 | $191.32 |
| KentuckyKentucky | $404.04 | $198.86 |
| New Orleans, LALouisiana | $422.90 | $205.72 |
| Rest of LouisianaLouisiana | $403.79 | $199.53 |
| Metropolitan Boston, MAMassachusetts | $493.89 | $218.31 |
| Rest of MassachusettsMassachusetts | $449.42 | $206.38 |
| Baltimore area, MDMaryland | $463.78 | $216.14 |
| Rest of MarylandMaryland | $439.63 | $206.06 |
| Rest of MaineMaine | $406.77 | $194.43 |
| Southern Maine, MEMaine | $426.66 | $197.93 |
| Detroit, MIMichigan | $440.58 | $217.86 |
| Rest of MichiganMichigan | $414.99 | $204.27 |
| MinnesotaMinnesota | $430.49 | $193.00 |
| Metropolitan Kansas City, MOMissouri | $419.16 | $202.44 |
| Metropolitan St. Louis, MOMissouri | $423.27 | $203.55 |
| Rest of MissouriMissouri | $397.73 | $198.78 |
| MississippiMississippi | $392.74 | $194.02 |
| MontanaMontana | $436.51 | $205.71 |
| North CarolinaNorth Carolina | $410.72 | $195.38 |
| North DakotaNorth Dakota | $424.65 | $193.85 |
| NebraskaNebraska | $402.71 | $189.68 |
| New HampshireNew Hampshire | $445.42 | $205.16 |
| Northern New JerseyNew Jersey | $491.08 | $223.35 |
| Rest of New JerseyNew Jersey | $469.59 | $217.55 |
| New MexicoNew Mexico | $417.54 | $205.90 |
| NevadaNevada | $433.48 | $202.45 |
| NYC suburbs and Long Island, NYNew York | $515.08 | $240.65 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $473.38 | $220.65 |
| Queens, NYNew York | $504.82 | $232.01 |
| Rest of New YorkNew York | $416.72 | $197.46 |
| OhioOhio | $412.56 | $201.84 |
| OklahomaOklahoma | $402.38 | $196.28 |
| Portland, OROregon | $464.45 | $208.03 |
| Rest of OregonOregon | $429.49 | $199.61 |
| Metropolitan Philadelphia, PAPennsylvania | $454.30 | $214.04 |
| Rest of PennsylvaniaPennsylvania | $412.69 | $200.81 |
| Puerto RicoPuerto Rico | $439.30 | $205.96 |
| Rhode IslandRhode Island | $446.18 | $207.77 |
| South CarolinaSouth Carolina | $412.45 | $199.19 |
| South DakotaSouth Dakota | $423.24 | $192.44 |
| TennesseeTennessee | $402.01 | $192.22 |
| Austin, TXTexas | $450.64 | $206.45 |
| Beaumont, TXTexas | $410.15 | $200.12 |
| Brazoria, TXTexas | $430.75 | $202.03 |
| Dallas, TXTexas | $433.84 | $203.97 |
| Fort Worth, TXTexas | $431.33 | $203.76 |
| Galveston, TXTexas | $432.27 | $203.09 |
| Houston, TXTexas | $443.25 | $214.07 |
| Rest of TexasTexas | $420.45 | $201.42 |
| UtahUtah | $417.85 | $200.90 |
| Virgin Islands, VIUnited States Virgin Islands | $439.30 | $205.96 |
| VermontVermont | $423.87 | $195.38 |
| Rest of WashingtonWashington | $448.28 | $205.24 |
| King County, WAWashington | $502.84 | $219.64 |
| WisconsinWisconsin | $411.02 | $189.92 |
| West VirginiaWest Virginia | $408.83 | $208.26 |
| WyomingWyoming | $431.34 | $200.54 |
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.
The exact Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,535
- Code
- 31254
- Physician work
- 4.16
- Practice expense
- 8.31
- Malpractice
- 0.60
GPCI2026.csv
106
- Locality
- Virginia
- Physician work
- 1.000
- Practice expense
- 0.983
- Malpractice
- 0.706
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.16 | × 1.000 | 4.1600 |
| Practice expense | 8.31 | × 0.983 | 8.1687 |
| Malpractice | 0.60 | × 0.706 | 0.4236 |
| Total RVUs | 12.7523 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Virginia$425.94
Office: (4.16 × 1 + 8.31 × 0.983 + 0.6 × 0.706) × $33.4009 = $425.94
Facility: (4.16 × 1 + 1.4 × 0.983 + 0.6 × 0.706) × $33.4009 = $199.06
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).
How 31254 has changed in Virginia
31254 · Office / nonfacility
$425.94
Effective 2026-10-01
The base rate is $10.38 higher than on 2025-10-01, moving from $415.56 to $425.94 (2.5%).
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
$415.56changed to$425.94
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 4.27 changed to 4.16
- Practice expense RVU 8.24 changed to 8.31
- Malpractice RVU 0.61 changed to 0.60
- Work GPCI 1.002 changed to 1.000
- Practice expense GPCI 0.984 changed to 0.983
- Malpractice GPCI 0.755 changed to 0.706
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$427.98changed to$415.56
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 8.25 changed to 8.24
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$421.00changed to$427.98
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$441.68changed to$421.00
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 8.36 changed to 8.25
- Malpractice RVU 0.59 changed to 0.61
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 0.990 changed to 0.984
- Malpractice GPCI 0.826 changed to 0.755
January 1, 2023
RVU23A
$452.53changed to$441.68
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 8.31 changed to 8.36
- Malpractice RVU 0.60 changed to 0.59
- Practice expense GPCI 0.995 changed to 0.990
- Malpractice GPCI 0.897 changed to 0.826
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$446.25changed to$452.53
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 8.03 changed to 8.31
- Malpractice RVU 0.59 changed to 0.60
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$428.36changed to$446.25
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 7.14 changed to 8.03
- Malpractice RVU 0.58 changed to 0.59
- Practice expense GPCI 0.991 changed to 0.995
- Malpractice GPCI 0.903 changed to 0.897
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$419.04changed to$428.36
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 6.90 changed to 7.14
- Malpractice RVU 0.61 changed to 0.58
- Practice expense GPCI 0.986 changed to 0.991
- Malpractice GPCI 0.908 changed to 0.903
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$410.06changed to$419.04
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 6.66 changed to 6.90
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
No ratechanged to$410.06
Held through RVU18B, RVU18C, RVU18D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $425.94 | $199.06 | RVU26D |
| 2026-07-01 | $425.94 | $199.06 | RVU26C |
| 2026-04-01 | $425.94 | $199.06 | RVU26B |
| 2026-01-01 | $425.94 | $199.06 | RVU26A |
| 2025-10-01 | $415.56 | $229.68 | RVU25D |
| 2025-07-01 | $415.56 | $229.68 | RVU25C |
| 2025-04-01 | $415.56 | $229.68 | RVU25B |
| 2025-01-01 | $415.56 | $229.68 | RVU25A |
| 2024-10-01 | $427.98 | $235.38 | RVU24D |
| 2024-07-01 | $427.98 | $235.38 | RVU24C |
| 2024-04-01 | $427.98 | $235.38 | RVU24B |
| 2024-03-09 | $427.98 | $235.38 | RVU24AR |
| 2024-01-01 | $421.00 | $231.54 | RVU24A |
| 2023-10-01 | $441.68 | $240.72 | RVU23D |
| 2023-07-01 | $441.68 | $240.72 | RVU23C |
| 2023-04-01 | $441.68 | $240.72 | RVU23B |
| 2023-01-01 | $441.68 | $240.72 | RVU23A |
| 2022-10-01 | $452.53 | $244.56 | RVU22D |
| 2022-07-01 | $452.53 | $244.56 | RVU22C |
| 2022-04-01 | $452.53 | $244.56 | RVU22B |
| 2022-01-01 | $452.53 | $244.56 | RVU22A |
| 2021-10-01 | $446.25 | $243.49 | RVU21D |
| 2021-07-01 | $446.25 | $243.49 | RVU21C |
| 2021-04-01 | $446.25 | $243.49 | RVU21B |
| 2021-01-01 | $446.25 | $243.49 | RVU21A |
| 2020-10-01 | $428.36 | $249.18 | RVU20D |
| 2020-07-01 | $428.36 | $249.18 | RVU20C |
| 2020-04-01 | $428.36 | $249.18 | RVU20B |
| 2020-01-01 | $428.36 | $249.18 | RVU20A |
| 2019-10-01 | $419.04 | $249.54 | RVU19D |
| 2019-07-01 | $419.04 | $249.54 | RVU19C |
| 2019-04-01 | $419.04 | $249.54 | RVU19B |
| 2019-01-01 | $419.04 | $249.54 | RVU19A |
| 2018-10-01 | $410.06 | $248.55 | RVU18D |
| 2018-07-01 | $410.06 | $248.55 | RVU18C |
| 2018-04-01 | $410.06 | $248.55 | RVU18B |
| 2018-01-01 | $410.06 | $248.55 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $276.08 | RVU17D |
| 2017-07-01 | Not available in this setting | $276.08 | RVU17C |
| 2017-04-01 | Not available in this setting | $276.08 | RVU17B |
| 2017-01-01 | Not available in this setting | $276.08 | RVU17A |
| 2016-10-01 | Not available in this setting | $276.35 | RVU16D |
| 2016-07-01 | Not available in this setting | $276.35 | RVU16C |
| 2016-04-01 | Not available in this setting | $276.35 | RVU16B |
| 2016-01-01 | Not available in this setting | $276.35 | RVU16A |
| 2015-10-01 | Not available in this setting | $276.94 | RVU15D |
| 2015-07-01 | Not available in this setting | $276.94 | RVU15C |
| 2015-04-01 | Not available in this setting | $275.56 | RVU15B |
| 2015-01-01 | Not available in this setting | $275.56 | RVU15A |
| 2014-10-01 | Not available in this setting | $274.78 | RVU14D |
| 2014-07-01 | Not available in this setting | $274.78 | RVU14C |
| 2014-04-01 | Not available in this setting | $274.78 | RVU14B |
| 2014-01-01 | Not available in this setting | $274.78 | RVU14A |
| 2013-10-01 | Not available in this setting | $267.52 | RVU13D |
| 2013-07-01 | Not available in this setting | $267.52 | RVU13C |
| 2013-04-01 | Not available in this setting | $267.52 | RVU13B |
| 2013-01-01 | Not available in this setting | $267.52 | RVU13AR |
Where the Virginia rate applies
Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.
- Abbs Valley
- Abingdon
- Accomac
- Adwolf
- Afton
- Alberta
- Aldie
- Allison Gap
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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