CPT code 31295: Sinus dilation, maxillary sinus ostium2026 Medicare rate & RVUs in Missouri
Endoscopic balloon dilation of a maxillary sinus ostium is reported when an ENT surgeon enlarges its natural drainage opening without conventional tissue removal.
Medicare pays $1,373.41–$1,506.67 for 31295 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 31295 covers
An otolaryngologist uses a nasal endoscope to guide a balloon into the natural opening of a maxillary sinus and enlarge that drainage pathway. This approach may be used for obstructed maxillary sinus drainage, including in patients with chronic or recurrent sinusitis. The procedure is distinct from creating a wider opening by removing tissue or bone during conventional endoscopic sinus surgery.
Report the code for the maxillary sinus ostium dilation performed, and document the treated side, the sinus, the technique, and the clinical findings supporting the intervention. CMS treats the service as a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When related endoscopies are performed together, endoscopy family pricing applies. CMS allows payment for an assistant at surgery; 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 31295 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$1373.41 to $1506.67
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $1,487.15 | $132.56 |
| Metropolitan St. Louis, MO | $1,506.67 | $133.33 |
| Rest of Missouri | $1,373.41 | $129.90 |
How the 31295 rate is calculated
Each of 31295’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 · 31295
RVUs × geographic indexes × conversion factor
Work2.63
2.63 RVUs× 1.000 GPCI
Practice expense44.21
44.21 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
47.2300
Conversion factor
$33.4009
Medicare rate
$1,577.52
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31295
The CMS indicators that decide how 31295 is paid alongside other services.
CMS payment indicators · 31295
Sinus dilation, maxillary sinus ostium
| 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) | 2 | Paid. |
| 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
31295 without 50 · national office
$1,577.52
Sinus dilation, maxillary sinus ostium
31295-50 · Bilateral: 150%
$2,366.28
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).
31295 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31296Sinus dilationFrontal sinus
- 31296 is the frontal sinus balloon-dilation service. Choose 31295 when the treated ostium is maxillary.
- 31297Sinus dilationSphenoid ostium
- 31297 applies to balloon dilation of the sphenoid sinus ostium, not the maxillary ostium.
- 31256Maxillary antrostomyWithout tissue removal
- 31256 represents conventional endoscopic maxillary sinus exploration and opening. Use 31295 when the documented intervention is balloon dilation of the ostium.
- 31267Sinus endoscopyMaxillary tissue removal
- 31267 includes removal of tissue from the maxillary sinus. The defining intervention for 31295 is balloon dilation of the ostium.
31295 billing questions
How does this differ from 31256?
31295 describes balloon dilation of the maxillary sinus opening. Code 31256 is used for a conventional endoscopic maxillary sinus exploration and opening rather than balloon dilation.
When would 31267 be a better fit?
Use 31267 when the maxillary sinus procedure includes removal of tissue. Balloon dilation of the ostium without that tissue removal is the distinguishing service for 31295.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure: report modifier 50 for bilateral treatment. CMS pays the bilateral service at 150%.
What happens when another sinus endoscopy is performed during the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The operative report should identify each sinus procedure performed.
Is same-day postoperative care separately included in the global period?
No. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant surgeon be reported?
CMS may pay for an assistant at surgery. Co-surgeons and team surgery are not permitted for this service.
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
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