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CPT code 31257: Sinus endoscopy, total ethmoidectomy and sphenoidotomy2026 Medicare rate & RVUs

Reports endoscopic removal of anterior and posterior ethmoid tissue with an opening into the sphenoid sinus during surgical treatment of chronic sinus disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities5.3K Medicare services in 2024

Medicare pays $375.09 for 31257 nationally in a facility.

Medicare rate · 31257

Sinus endoscopy, total ethmoidectomy and sphenoidotomy

Office or facility?

Work RVUs
7.8
Total RVUs
11.23
Global days
000

National rate · 2026

$375.09

Facility setting, before claim adjustments.

See every locality for 31257 →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.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 31257 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 31257 covers

An otolaryngologist performs this endoscopic operation to remove ethmoid air-cell tissue from both the anterior and posterior portions of the ethmoid sinus and create an opening into the sphenoid sinus. It may be part of surgery for chronic rhinosinusitis when disease involves both sinus regions. The sphenoid sinus is opened, but removal of tissue from within that sinus is not part of this code’s distinguishing service.

Select the code when the operative report supports the complete ethmoidectomy and sphenoidotomy; distinguish it from a sphenoid procedure that also removes sphenoid tissue. Document the treated sides and the work performed in each sinus. The 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. For bilateral reporting, modifier 50 is paid at 150%. Medicare does not pay for an assistant at surgery, and 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 31257 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

31257 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$349.01
AlaskaUnavailable$493.23
ArizonaUnavailable$367.24
ArkansasUnavailable$345.84
Atlanta, GAUnavailable$384.75
Austin, TXUnavailable$375.71
Bakersfield, CAUnavailable$372.50
Baltimore area, MDUnavailable$393.87
Beaumont, TXUnavailable$365.50
Brazoria, TXUnavailable$368.11

31257 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
31257 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 31257 rate is calculated

Each of 31257’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 · 31257

RVUs × geographic indexes × conversion factor

Office or facility?

Work7.80

7.80 RVUs× 1.000 GPCI

Practice expense2.29

2.29 RVUs× 1.000 GPCI

Malpractice1.14

1.14 RVUs× 1.000 GPCI

Adjusted RVUs

11.2300

Conversion factor

$33.4009

Medicare rate

$375.09

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 31257

The CMS indicators that decide how 31257 is paid alongside other services.

CMS payment indicators · 31257

Sinus endoscopy, total ethmoidectomy and sphenoidotomy

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)1Not paid (statutory restriction).
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

31257 without 50 · national facility

$375.09

Sinus endoscopy, total ethmoidectomy and sphenoidotomy

31257-50 · Bilateral: 150%

$562.63

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

31257 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 31257

    Sinus endoscopy, total ethmoidectomy and sphenoidotomy7.8 wRVU

    Not priced

  • 31255

    Ethmoidectomy, total, anterior and posterior cells5.61 wRVU

    Not priced

  • 31259

    Sinus endoscopy, total ethmoidectomy, sphenoid tissue removal8.27 wRVU

    Not priced

  • 31287

    Sphenoidotomy, without tissue removal3.41 wRVU

    Not priced

  • 31253

    Sinus endoscopy, total ethmoidectomy and frontal exploration8.78 wRVU

    Not priced

How to choose

31255EthmoidectomyTotal, anterior and posterior cells
31255 represents total ethmoidectomy without sphenoidotomy. Choose 31257 when the surgeon also creates an opening into the sphenoid sinus.
31259Sinus endoscopyTotal ethmoidectomy, sphenoid tissue removal
31259 includes removal of tissue from within the sphenoid sinus; 31257 describes sphenoidotomy without that tissue-removal element.
31287SphenoidotomyWithout tissue removal
31287 covers sphenoidotomy without total ethmoidectomy. Use 31257 when the surgeon performs both sphenoidotomy and total ethmoidectomy.
31253Sinus endoscopyTotal ethmoidectomy and frontal exploration
31253 pairs total ethmoidectomy with frontal sinus work. Code 31257 pairs total ethmoidectomy with sphenoidotomy instead.

Codes related to 31257

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

Codes related to 31257
CodeHow it relatesNational office range
Same family
31255Ethmoidectomy, total, anterior and posterior cellsTotal ethmoidectomy without the sphenoidotomy included in 31257.No office rate
31259Sinus endoscopy, total ethmoidectomy, sphenoid tissue removalAdds removal of tissue from the sphenoid sinus.No office rate
31253Sinus endoscopy, total ethmoidectomy and frontal explorationCombines total ethmoidectomy with frontal sinus work rather than sphenoidotomy.No office rate
Used instead
31287Sphenoidotomy, without tissue removalSphenoidotomy without the total ethmoidectomy included in 31257.No office rate
31288Sphenoid surgery, sphenoid tissue removalSphenoidotomy with tissue removal, without the total ethmoidectomy included in 31257.No office rate

31257 billing questions

How is this different from 31259?

31259 includes removal of tissue from the sphenoid sinus in addition to the total ethmoidectomy and sphenoidotomy. Use 31257 when the sphenoid sinus is opened but sphenoid tissue removal is not performed.

Can 31255 be reported with 31257 for the same ethmoidectomy?

31257 already includes total ethmoidectomy. Do not separately report 31255 for that same ethmoid work.

What documentation supports reporting 31257?

The operative report should establish removal of anterior and posterior ethmoid tissue and creation of an opening into the sphenoid sinus. Document the side or sides treated and whether tissue was removed from within the sphenoid sinus.

How should bilateral surgery be reported?

Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.

Can an assistant surgeon or co-surgeon be billed?

CMS does not pay for an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

What happens when other related sinus endoscopies are performed in the same session?

Endoscopy family pricing applies when related endoscopies are performed together. The 0-day global period includes same-day preoperative and postoperative care.

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 31257PPRRVU2026_Oct_nonQPP.csv, line 3,538 (RVU26D)

Open CMS sourceHow we calculate rates

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