CPT code 31291: CSF leak repair, sphenoid region2026 Medicare rate & RVUs in Connecticut

Reports endoscopic repair of a cerebrospinal fluid leak arising in the sphenoid region, typically performed transnasally by an otolaryngologist or skull-base surgeon.

CMS RVU26DEffective Oct 1, 2026One payment locality112 Medicare services in 2024

In Connecticut, Medicare pays $1,139.76 for 31291 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$1,139.76Hospital or facility

Check a contract rate as a % of Medicare · 31291 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 31291 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 31291 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 31291 covers

This service repairs a cerebrospinal fluid leak in the sphenoid region through a nasal endoscope. An otolaryngologist, rhinologist, or skull-base surgeon typically identifies the leak and closes the defect, often with graft material or a tissue flap. The operation is generally performed in a hospital or ambulatory surgery setting; the operative note should establish the sphenoid site and describe the endoscopic repair rather than sinus surgery for routine inflammatory disease.

Select this code based on the location of the leak, not simply because the surgeon worked in the sphenoid sinus. The record should document the leak site, endoscopic approach, and repair performed. Related endoscopies performed during the same session are subject to endoscopy-family pricing. CMS assigns a 10-day global period, including related postoperative visits during that period. For bilateral reporting, 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.

How Connecticut compares for 31291

Across 109 of 109 payment localities, the facility rate for 31291 runs from $972.65 in Arkansas to $1,360.91 in Alaska. Connecticut pays $1,139.76. The RVUs are the same everywhere; the geographic indexes change the dollars.

31291 in Connecticut vs other payment areas
  1. Connecticut · this page$1,139.76
  2. Los Angeles, CA · California$1,119.84−$19.92
  3. Washington, DC area · District of Columbia$1,181.57+$41.81
  4. Miami, FL · Florida$1,277.28+$137.52
  5. Chicago, IL · Illinois$1,241.63+$101.87
  6. Manhattan, NY · New York$1,240.85+$101.09
  7. Alaska · Alaska$1,360.91+$221.15

Other areas in Connecticut first, then benchmark localities. Bars start at $0.

Every other payment area

31291 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama—$983.98
ArkansasArkansas—$972.65
ArizonaArizona—$1,049.36
Bakersfield, CACalifornia—$1,071.48
Chico, CACalifornia—$1,061.26
El Centro, CACalifornia—$1,061.87
Fresno, CACalifornia—$1,061.26
Hanford, CACalifornia—$1,061.26

31291 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.

View every state and territory as a table
31291 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

See 31291 in every payment locality

How the 31291 rate is calculated

Each of 31291’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 · 31291

RVUs × geographic indexes × conversion factor

Office or facility?

Work19.07

19.07 RVUs× 1.000 GPCI

Practice expense9.50

9.50 RVUs× 1.000 GPCI

Malpractice3.67

3.67 RVUs× 1.000 GPCI

Adjusted RVUs

32.2400

Conversion factor

$33.4009

Medicare rate

$1,076.85

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

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,546

Code
31291
Physician work
19.07
Practice expense
9.50
Malpractice
3.67

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Facility calculation for 31291 in Connecticut
ComponentRVULocality factorAdjusted
Physician work19.07× 1.02019.4514
Practice expense9.50× 1.07710.2315
Malpractice3.67× 1.2104.4407
Total RVUs34.1236
Conversion factor× 33.4009

Facility rate, Connecticut$1139.76

Facility: (19.07 × 1.02 + 9.5 × 1.077 + 3.67 × 1.21) × $33.4009 = $1139.76

Open 31291 in the RVU calculator

Payment rules and modifiers for 31291

31291 has a 10-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 31291

CSF leak repair, sphenoid 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 · 31291

CSF leak repair, sphenoid 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

31291 without 50 · national facility

$1,076.85

CSF leak repair, sphenoid region

31291-50 · Bilateral: 150%

$1,615.28

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

How 31291 has changed in Connecticut

31291 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

Base rate by release · bars start at $0 · select a bar to compare

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$1,139.76RVU26D
2026-07-01Not available in this setting$1,139.76RVU26C
2026-04-01Not available in this setting$1,139.76RVU26B
2026-01-01Not available in this setting$1,139.76RVU26A
2025-10-01Not available in this setting$1,271.76RVU25D
2025-07-01Not available in this setting$1,271.76RVU25C
2025-04-01Not available in this setting$1,271.76RVU25B
2025-01-01Not available in this setting$1,271.76RVU25A
2024-10-01Not available in this setting$1,303.12RVU24D
2024-07-01Not available in this setting$1,303.12RVU24C
2024-04-01Not available in this setting$1,303.12RVU24B
2024-03-09Not available in this setting$1,303.12RVU24AR
2024-01-01Not available in this setting$1,281.85RVU24A
2023-10-01Not available in this setting$1,309.86RVU23D
2023-07-01Not available in this setting$1,309.86RVU23C
2023-04-01Not available in this setting$1,309.86RVU23B
2023-01-01Not available in this setting$1,309.86RVU23A
2022-10-01Not available in this setting$1,306.32RVU22D
2022-07-01Not available in this setting$1,306.32RVU22C
2022-04-01Not available in this setting$1,306.32RVU22B
2022-01-01Not available in this setting$1,306.32RVU22A
2021-10-01Not available in this setting$1,302.51RVU21D
2021-07-01Not available in this setting$1,302.51RVU21C
2021-04-01Not available in this setting$1,302.51RVU21B
2021-01-01Not available in this setting$1,302.51RVU21A
2020-10-01Not available in this setting$1,342.36RVU20D
2020-07-01Not available in this setting$1,342.36RVU20C
2020-04-01Not available in this setting$1,342.36RVU20B
2020-01-01Not available in this setting$1,342.36RVU20A
2019-10-01Not available in this setting$1,353.75RVU19D
2019-07-01Not available in this setting$1,353.75RVU19C
2019-04-01Not available in this setting$1,353.75RVU19B
2019-01-01Not available in this setting$1,353.75RVU19A
2018-10-01Not available in this setting$1,355.50RVU18D
2018-07-01Not available in this setting$1,355.50RVU18C
2018-04-01Not available in this setting$1,355.50RVU18B
2018-01-01Not available in this setting$1,355.50RVU18AR1
2017-10-01Not available in this setting$1,363.18RVU17D
2017-07-01Not available in this setting$1,363.18RVU17C
2017-04-01Not available in this setting$1,363.18RVU17B
2017-01-01Not available in this setting$1,363.18RVU17A
2016-10-01Not available in this setting$1,372.79RVU16D
2016-07-01Not available in this setting$1,372.79RVU16C
2016-04-01Not available in this setting$1,372.79RVU16B
2016-01-01Not available in this setting$1,372.79RVU16A
2015-10-01Not available in this setting$1,377.70RVU15D
2015-07-01Not available in this setting$1,377.70RVU15C
2015-04-01Not available in this setting$1,370.85RVU15B
2015-01-01Not available in this setting$1,370.85RVU15A
2014-10-01Not available in this setting$1,359.05RVU14D
2014-07-01Not available in this setting$1,359.05RVU14C
2014-04-01Not available in this setting$1,359.05RVU14B
2014-01-01Not available in this setting$1,359.05RVU14A
2013-10-01Not available in this setting$1,335.32RVU13D
2013-07-01Not available in this setting$1,335.32RVU13C
2013-04-01Not available in this setting$1,335.32RVU13B
2013-01-01Not available in this setting$1,335.32RVU13AR

Price 31291 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

31291 billing questions

How is this distinguished from 31290?

Use 31291 when the cerebrospinal fluid leak being repaired is in the sphenoid region. Code 31290 is for a leak in the ethmoid region.

Does this code cover ordinary sphenoid sinus surgery?

No. It represents endoscopic repair of a cerebrospinal fluid leak in the sphenoid region, not routine sphenoidotomy or removal of sinus tissue.

Can another nasal or sinus endoscopy be reported in the same session?

Related endoscopies performed together are subject to CMS endoscopy-family pricing. The operative record should identify each distinct service and its site.

What documentation supports reporting this code?

Document the sphenoid location of the leak, the endoscopic approach, and the repair performed. The site helps distinguish this code from ethmoid-region leak repair.

How are bilateral procedures and assistant services handled?

CMS pays bilateral reporting with modifier 50 at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.

What postoperative care is included?

The 10-day global period includes related postoperative visits during those 10 days.

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 31291PPRRVU2026_Oct_nonQPP.csv, line 3,546 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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