CPT code 31259: Sinus endoscopy, total ethmoidectomy, sphenoid tissue removal2026 Medicare rate & RVUs in Florida
Reports endoscopic removal of anterior and posterior ethmoid tissue combined with sphenoid sinus opening and removal of sphenoid sinus tissue.
CMS doesn’t publish an office rate for 31259 in Florida.
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
On this page 9 sections
What 31259 covers
An otolaryngologist, often a rhinologist, performs this endoscopic sinus operation to treat disease involving both the ethmoid and sphenoid sinuses. The surgeon removes tissue from the anterior and posterior ethmoid air cells, opens the sphenoid sinus, and removes tissue from within it. Typical cases involve chronic inflammatory disease or polyps affecting these areas, with surgery commonly performed in an operating room.
Select this code when the operative report supports the full ethmoid work and removal of tissue from the sphenoid sinus; an opening alone is not enough for the tissue-removal component. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. For bilateral surgery, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery, and does not permit co-surgeons or team surgery for this service.
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 31259 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | $431.10 |
| Miami, FL | Unavailable | $462.73 |
| Rest of Florida | Unavailable | $414.11 |
How the 31259 rate is calculated
Each of 31259’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 · 31259
RVUs × geographic indexes × conversion factor
Work8.27
8.27 RVUs× 1.000 GPCI
Practice expense2.40
2.40 RVUs× 1.000 GPCI
Malpractice1.22
1.22 RVUs× 1.000 GPCI
Adjusted RVUs
11.8900
Conversion factor
$33.4009
Medicare rate
$397.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31259
The CMS indicators that decide how 31259 is paid alongside other services.
CMS payment indicators · 31259
Sinus endoscopy, total ethmoidectomy, sphenoid tissue removal
| 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
31259 without 50 · national facility
$397.14
Sinus endoscopy, total ethmoidectomy, sphenoid tissue removal
31259-50 · Bilateral: 150%
$595.71
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).
31259 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 31257Sinus endoscopyTotal ethmoidectomy and sphenoidotomy
- Choose 31259 when tissue is removed from the sphenoid sinus. Choose 31257 when the sphenoid sinus is opened without that tissue removal, with total ethmoid work also performed.
- 31255EthmoidectomyTotal, anterior and posterior cells
- 31255 represents total ethmoid work without a sphenoid procedure. It does not capture sphenoidotomy or sphenoid tissue removal.
- 31288Sphenoid surgerySphenoid tissue removal
- 31288 covers sphenoidotomy with sphenoid tissue removal when total ethmoidectomy is not part of the service. Use 31259 when the total ethmoid work is also performed.
31259 billing questions
How does this differ from 31257?
Use 31259 when tissue is removed from the sphenoid sinus along with the total ethmoid work. Code 31257 describes the combination without sphenoid tissue removal.
Can I report 31257 separately for the same side?
Do not separately report 31257 for the ethmoidectomy and sphenoidotomy already represented by 31259 on that side. The operative report should support the added sphenoid tissue removal.
What documentation supports the tissue-removal portion?
The operative note should identify tissue removed from within the sphenoid sinus, in addition to the anterior and posterior ethmoid work. A sphenoid opening by itself does not establish that detail.
How is bilateral surgery reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
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.
What happens when other sinus endoscopies are performed in the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The operative documentation should distinguish the sinus sites and work performed.
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
Fee sheets · Coming soon
Put 31259 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist