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CPT code 31290: CSF leak repair, ethmoid region2026 Medicare rate & RVUs

Reports endoscopic repair of a cerebrospinal fluid leak at the ethmoid region, such as a skull-base defect causing clear nasal drainage.

CMS RVU26DEffective Oct 1, 2026109 payment localities95 Medicare services in 2024

Medicare pays $992.34 for 31290 nationally in a facility.

Medicare rate · 31290

CSF leak repair, ethmoid region

Office or facility?

Work RVUs
18.14
Total RVUs
29.71
Global days
010

National rate · 2026

$992.34

Facility setting, before claim adjustments.

See every locality for 31290 →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 31290 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 31290 covers

An otolaryngologist, often a rhinologist, uses a nasal endoscope to locate and close a cerebrospinal fluid leak involving the ethmoid region of the skull base. The repair may use graft material or a vascularized flap to seal the defect. Typical situations include persistent clear nasal drainage from a spontaneous, traumatic, or prior surgical skull-base opening. The procedure is generally performed in an operating room, commonly in a hospital outpatient or inpatient setting.

Report 31290 when the operative documentation identifies repair of a CSF leak in the ethmoid region; a sinus exploration or ethmoidectomy alone is not this service. The operative report should support the leak site and describe the endoscopic repair. CMS assigns a 10-day global period, which includes related postoperative visits during that period. When related nasal or sinus endoscopies are performed together, endoscopy-family pricing applies. For bilateral procedures, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; 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 31290 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

31290 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$914.72
AlaskaUnavailable$1,271.65
ArizonaUnavailable$969.64
ArkansasUnavailable$905.22
Atlanta, GAUnavailable$1,017.89
Austin, TXUnavailable$999.65
Bakersfield, CAUnavailable$994.76
Baltimore area, MDUnavailable$1,045.80
Beaumont, TXUnavailable$959.36
Brazoria, TXUnavailable$973.69

31290 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
31290 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 31290 rate is calculated

Each of 31290’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 · 31290

RVUs × geographic indexes × conversion factor

Office or facility?

Work18.14

18.14 RVUs× 1.000 GPCI

Practice expense8.73

8.73 RVUs× 1.000 GPCI

Malpractice2.84

2.84 RVUs× 1.000 GPCI

Adjusted RVUs

29.7100

Conversion factor

$33.4009

Medicare rate

$992.34

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

Payment rules and modifiers for 31290

31290 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 31290

CSF leak repair, ethmoid region

RuleCMS valueWhat it means
Global period010Minor procedure: the day of the procedure plus 10 days after are 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)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.80/0.10Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 31290

CSF leak repair, ethmoid region

10-day global period ends

Oct 11, 2026

Covers Oct 1, 2026 through Oct 11, 2026 (11 days).

Visit on Oct 31, 2026

After the global period ends: visits and procedures are billed normally.

SurgeryVisit
Sep 28, 2026Oct 14, 2026

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

31290 without 50 · national facility

$992.34

CSF leak repair, ethmoid region

31290-50 · Bilateral: 150%

$1,488.51

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

31290 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 31290

    CSF leak repair, ethmoid region18.14 wRVU

    Not priced

  • 31291

    CSF leak repair, sphenoid region19.07 wRVU

    Not priced

  • 31254

    Ethmoidectomy, partial, anterior ethmoid4.16 wRVU

    $436.55

  • 31255

    Ethmoidectomy, total, anterior and posterior cells5.61 wRVU

    Not priced

  • 31288

    Sphenoid surgery, sphenoid tissue removal4 wRVU

    Not priced

How to choose

31291CSF leak repairSphenoid region
Both codes report endoscopic CSF leak repair, but the repair site determines the choice: ethmoid region for 31290 and sphenoid region for 31291.
31254EthmoidectomyPartial, anterior ethmoid
31254 reports partial ethmoidectomy, not repair of a CSF leak. Use 31290 when the documented service is endoscopic closure of an ethmoid-region leak.
31255EthmoidectomyTotal, anterior and posterior cells
31255 reports total ethmoidectomy. It is not a substitute for 31290 when the procedure repairs an ethmoid-region CSF leak.
31288Sphenoid surgerySphenoid tissue removal
31288 involves sphenoidotomy with tissue removal. It does not describe repair of a CSF leak in the ethmoid region.

Codes related to 31290

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

Codes related to 31290
CodeHow it relatesNational office range
Same family
31291CSF leak repair, sphenoid regionEndoscopic CSF leak repair at the sphenoid region rather than the ethmoid region.No office rate
31254Ethmoidectomy, partial, anterior ethmoidPartial ethmoidectomy; removal of ethmoid tissue is distinct from leak repair.$387.69–$565.22
31255Ethmoidectomy, total, anterior and posterior cellsTotal ethmoidectomy; tissue removal is distinct from repair of a CSF leak.No office rate
31287Sphenoidotomy, without tissue removalEndoscopic sphenoidotomy without the ethmoid-region CSF leak repair described by 31290.No office rate
31288Sphenoid surgery, sphenoid tissue removalSphenoidotomy with tissue removal, a different service from ethmoid-region leak repair.No office rate

31290 billing questions

How is 31290 distinguished from 31291?

31290 is for endoscopic CSF leak repair in the ethmoid region. Use 31291 when the documented leak site is the sphenoid region.

Is an ethmoidectomy the same service as 31290?

No. An ethmoidectomy removes ethmoid sinus tissue, while 31290 reports endoscopic repair of a CSF leak at the ethmoid region. Select the code from the documented procedure.

How should bilateral repair be reported?

For a bilateral procedure, report modifier 50; CMS pays the bilateral procedure at 150%.

Are postoperative visits separately reported during the global period?

Related postoperative visits for 10 days are included in the 10-day global period.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.

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 31290PPRRVU2026_Oct_nonQPP.csv, line 3,545 (RVU26D)

Open CMS sourceHow we calculate rates

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