CPT code 31295: Sinus dilation, maxillary sinus ostium2026 Medicare rate & RVUs in North Dakota
Endoscopic balloon dilation of a maxillary sinus ostium is reported when an ENT surgeon enlarges its natural drainage opening without conventional tissue removal.
In North Dakota, Medicare pays $1,569.79 for 31295 in the office and $127.20 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 31295 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 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.
How North Dakota compares for 31295
Across 109 of 109 payment localities, the office rate for 31295 runs from $1,363.00 in Arkansas to $2,233.82 in San Benito County, CA. North Dakota pays $1,569.79. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$1,569.79
- Los Angeles, CA · California$1,846.98+$277.19
- Washington, DC area · District of Columbia$1,846.58+$276.79
- Miami, FL · Florida$1,657.98+$88.19
- Chicago, IL · Illinois$1,602.39+$32.60
- Manhattan, NY · New York$1,830.00+$260.21
- Alaska · Alaska$1,711.58+$141.79
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $1,387.29 | $125.03 |
| ArkansasArkansas | $1,363.00 | $123.82 |
| ArizonaArizona | $1,529.87 | $132.01 |
| Bakersfield, CACalifornia | $1,715.86 | $134.79 |
| Chico, CACalifornia | $1,714.73 | $133.66 |
| El Centro, CACalifornia | $1,714.80 | $133.72 |
| Fresno, CACalifornia | $1,714.73 | $133.66 |
| Hanford, CACalifornia | $1,714.73 | $133.66 |
| Madera, CACalifornia | $1,714.73 | $133.66 |
| Merced, CACalifornia | $1,714.73 | $133.66 |
| Modesto, CACalifornia | $1,714.73 | $133.66 |
| Napa, CACalifornia | $2,046.23 | $144.90 |
| Oxnard, CACalifornia | $1,843.82 | $138.69 |
| Redding, CACalifornia | $1,714.73 | $133.66 |
| Rest of CaliforniaCalifornia | $1,714.73 | $133.66 |
| Riverside, CACalifornia | $1,718.95 | $137.88 |
| Sacramento, CACalifornia | $1,815.34 | $137.61 |
| Salinas, CACalifornia | $1,808.99 | $137.04 |
| San Diego, CACalifornia | $1,863.62 | $138.29 |
| Marin County, CACalifornia | $2,184.25 | $150.21 |
| San Francisco, CACalifornia | $2,183.81 | $149.76 |
| San Benito County, CACalifornia | $2,233.82 | $153.62 |
| Santa Clara County, CACalifornia | $2,232.01 | $151.81 |
| San Luis Obispo, CACalifornia | $1,778.23 | $135.12 |
| Santa Cruz, CACalifornia | $1,890.81 | $138.06 |
| Santa Maria, CACalifornia | $1,819.06 | $137.01 |
| Santa Rosa, CACalifornia | $1,910.79 | $139.30 |
| Stockton, CACalifornia | $1,714.73 | $133.66 |
| Vallejo, CACalifornia | $2,045.59 | $144.26 |
| Visalia, CACalifornia | $1,714.73 | $133.66 |
| Yuba City, CACalifornia | $1,714.73 | $133.66 |
| ColoradoColorado | $1,670.23 | $135.32 |
| ConnecticutConnecticut | $1,695.72 | $142.06 |
| DelawareDelaware | $1,558.93 | $133.65 |
| Fort Lauderdale, FLFlorida | $1,607.25 | $145.91 |
| Rest of FloridaFlorida | $1,519.10 | $139.99 |
| Atlanta, GAGeorgia | $1,604.03 | $138.37 |
| Rest of GeorgiaGeorgia | $1,420.55 | $133.76 |
| Hawaii, Guam, HIHawaii | $1,774.34 | $134.12 |
| IowaIowa | $1,444.15 | $124.19 |
| IdahoIdaho | $1,452.53 | $125.35 |
| East St. Louis, ILIllinois | $1,472.60 | $145.42 |
| Rest of IllinoisIllinois | $1,456.39 | $139.31 |
| Suburban Chicago, ILIllinois | $1,628.07 | $146.53 |
| IndianaIndiana | $1,463.03 | $125.76 |
| KansasKansas | $1,429.30 | $125.21 |
| KentuckyKentucky | $1,412.51 | $130.05 |
| New Orleans, LALouisiana | $1,492.17 | $134.70 |
| Rest of LouisianaLouisiana | $1,407.16 | $130.47 |
| Metropolitan Boston, MAMassachusetts | $1,866.16 | $143.72 |
| Rest of MassachusettsMassachusetts | $1,654.55 | $135.51 |
| Baltimore area, MDMaryland | $1,689.81 | $141.92 |
| Rest of MarylandMaryland | $1,595.05 | $135.16 |
| Rest of MaineMaine | $1,454.47 | $127.29 |
| Southern Maine, MEMaine | $1,559.43 | $129.83 |
| Detroit, MIMichigan | $1,534.78 | $142.68 |
| Rest of MichiganMichigan | $1,450.74 | $133.66 |
| MinnesotaMinnesota | $1,611.18 | $126.76 |
| Metropolitan Kansas City, MOMissouri | $1,487.15 | $132.56 |
| Metropolitan St. Louis, MOMissouri | $1,506.67 | $133.33 |
| Rest of MissouriMissouri | $1,373.41 | $129.90 |
| MississippiMississippi | $1,368.87 | $126.80 |
| MontanaMontana | $1,577.50 | $134.91 |
| North CarolinaNorth Carolina | $1,473.89 | $127.95 |
| NebraskaNebraska | $1,455.72 | $124.21 |
| New HampshireNew Hampshire | $1,636.44 | $134.71 |
| Northern New JerseyNew Jersey | $1,820.21 | $146.81 |
| Rest of New JerseyNew Jersey | $1,718.15 | $142.85 |
| New MexicoNew Mexico | $1,457.58 | $134.73 |
| NevadaNevada | $1,576.83 | $132.80 |
| NYC suburbs and Long Island, NYNew York | $1,873.40 | $158.16 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,724.50 | $144.86 |
| Queens, NYNew York | $1,857.66 | $152.52 |
| Rest of New YorkNew York | $1,499.82 | $129.37 |
| OhioOhio | $1,449.16 | $132.08 |
| OklahomaOklahoma | $1,416.62 | $128.39 |
| Portland, OROregon | $1,739.50 | $136.79 |
| Rest of OregonOregon | $1,567.75 | $130.93 |
| Metropolitan Philadelphia, PAPennsylvania | $1,642.16 | $140.43 |
| Rest of PennsylvaniaPennsylvania | $1,455.72 | $131.43 |
| Puerto RicoPuerto Rico | $1,593.57 | $135.12 |
| Rhode IslandRhode Island | $1,626.52 | $136.33 |
| South CarolinaSouth Carolina | $1,463.34 | $130.40 |
| South DakotaSouth Dakota | $1,568.88 | $126.29 |
| TennesseeTennessee | $1,437.12 | $125.81 |
| Austin, TXTexas | $1,661.86 | $135.61 |
| Beaumont, TXTexas | $1,443.70 | $130.95 |
| Brazoria, TXTexas | $1,562.07 | $132.47 |
| Dallas, TXTexas | $1,570.56 | $133.74 |
| Fort Worth, TXTexas | $1,555.96 | $133.57 |
| Galveston, TXTexas | $1,565.65 | $133.16 |
| Houston, TXTexas | $1,572.79 | $140.30 |
| Rest of TexasTexas | $1,500.95 | $131.94 |
| UtahUtah | $1,487.60 | $131.57 |
| VirginiaVirginia | $1,548.59 | $130.53 |
| Virgin Islands, VIUnited States Virgin Islands | $1,593.57 | $135.12 |
| VermontVermont | $1,556.32 | $128.16 |
| Rest of WashingtonWashington | $1,653.82 | $134.77 |
| King County, WAWashington | $1,914.73 | $144.68 |
| WisconsinWisconsin | $1,506.49 | $124.49 |
| West VirginiaWest Virginia | $1,389.70 | $136.09 |
| WyomingWyoming | $1,574.14 | $131.55 |
31295 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.
$1,363.00
$1,974.28
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $1,711.58 | 1 |
| AL | $1,387.29 | 1 |
| AR | $1,363.00 | 1 |
| AZ | $1,529.87 | 1 |
| CA | $1,714.73–$2,233.82 | 29 |
| CO | $1,670.23 | 1 |
| CT | $1,695.72 | 1 |
| DC | $1,846.58 | 1 |
| DE | $1,558.93 | 1 |
| FL | $1,519.10–$1,657.98 | 3 |
| GA | $1,420.55–$1,604.03 | 2 |
| GU | $1,774.34 | 1 |
| HI | $1,774.34 | 1 |
| IA | $1,444.15 | 1 |
| ID | $1,452.53 | 1 |
| IL | $1,456.39–$1,628.07 | 4 |
| IN | $1,463.03 | 1 |
| KS | $1,429.30 | 1 |
| KY | $1,412.51 | 1 |
| LA | $1,407.16–$1,492.17 | 2 |
| MA | $1,654.55–$1,866.16 | 2 |
| MD | $1,595.05–$1,846.58 | 3 |
| ME | $1,454.47–$1,559.43 | 2 |
| MI | $1,450.74–$1,534.78 | 2 |
| MN | $1,611.18 | 1 |
| MO | $1,373.41–$1,506.67 | 3 |
| MS | $1,368.87 | 1 |
| MT | $1,577.50 | 1 |
| NC | $1,473.89 | 1 |
| ND | $1,569.79 | 1 |
| NE | $1,455.72 | 1 |
| NH | $1,636.44 | 1 |
| NJ | $1,718.15–$1,820.21 | 2 |
| NM | $1,457.58 | 1 |
| NV | $1,576.83 | 1 |
| NY | $1,499.82–$1,873.40 | 5 |
| OH | $1,449.16 | 1 |
| OK | $1,416.62 | 1 |
| OR | $1,567.75–$1,739.50 | 2 |
| PA | $1,455.72–$1,642.16 | 2 |
| PR | $1,593.57 | 1 |
| RI | $1,626.52 | 1 |
| SC | $1,463.34 | 1 |
| SD | $1,568.88 | 1 |
| TN | $1,437.12 | 1 |
| TX | $1,443.70–$1,661.86 | 8 |
| UT | $1,487.60 | 1 |
| VA | $1,548.59–$1,846.58 | 2 |
| VI | $1,593.57 | 1 |
| VT | $1,556.32 | 1 |
| WA | $1,653.82–$1,914.73 | 2 |
| WI | $1,506.49 | 1 |
| WV | $1,389.70 | 1 |
| WY | $1,574.14 | 1 |
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.
The exact North Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,550
- Code
- 31295
- Physician work
- 2.63
- Practice expense
- 44.21
- Malpractice
- 0.39
GPCI2026.csv
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.63 | × 1.000 | 2.6300 |
| Practice expense | 44.21 | × 1.000 | 44.2100 |
| Malpractice | 0.39 | × 0.406 | 0.1583 |
| Total RVUs | 46.9983 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$1569.79
Office: (2.63 × 1 + 44.21 × 1 + 0.39 × 0.406) × $33.4009 = $1569.79
Facility: (2.63 × 1 + 1.02 × 1 + 0.39 × 0.406) × $33.4009 = $127.20
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).
How 31295 has changed in North Dakota
31295 · Office / nonfacility
$1569.79
Effective 2026-10-01
The base rate is $53.98 higher than on 2025-10-01, moving from $1515.81 to $1569.79 (3.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$1515.81changed to$1569.79
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.70 changed to 2.63
- Practice expense RVU 43.96 changed to 44.21
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1634.47changed to$1515.81
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 46.20 changed to 43.96
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$1607.79changed to$1634.47
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1714.54changed to$1607.79
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 47.72 changed to 46.20
- Malpractice RVU 0.37 changed to 0.39
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$1786.65changed to$1714.54
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 48.76 changed to 47.72
- Malpractice RVU 0.39 changed to 0.37
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1924.68changed to$1786.65
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 52.30 changed to 48.76
- Malpractice RVU 0.37 changed to 0.39
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$1925.36changed to$1924.68
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 50.47 changed to 52.30
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$1998.39changed to$1925.36
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 52.54 changed to 50.47
- Malpractice RVU 0.39 changed to 0.37
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$2048.20changed to$1998.39
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 53.99 changed to 52.54
- Malpractice RVU 0.38 changed to 0.39
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$2050.44changed to$2048.20
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 54.22 changed to 53.99
- Malpractice RVU 0.39 changed to 0.38
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$2083.67changed to$2050.44
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 55.28 changed to 54.22
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$2091.03changed to$2083.67
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 55.27 changed to 55.28
- Malpractice RVU 0.40 changed to 0.39
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$2080.62changed to$2091.03
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$2098.75changed to$2080.62
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 55.71 changed to 55.27
- Malpractice RVU 0.33 changed to 0.40
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$2224.12changed to$2098.75
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 62.49 changed to 55.71
- Malpractice RVU 0.35 changed to 0.33
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $2224.12
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,569.79 | $127.20 | RVU26D |
| 2026-07-01 | $1,569.79 | $127.20 | RVU26C |
| 2026-04-01 | $1,569.79 | $127.20 | RVU26B |
| 2026-01-01 | $1,569.79 | $127.20 | RVU26A |
| 2025-10-01 | $1,515.81 | $147.23 | RVU25D |
| 2025-07-01 | $1,515.81 | $147.23 | RVU25C |
| 2025-04-01 | $1,515.81 | $147.23 | RVU25B |
| 2025-01-01 | $1,515.81 | $147.23 | RVU25A |
| 2024-10-01 | $1,634.47 | $150.51 | RVU24D |
| 2024-07-01 | $1,634.47 | $150.51 | RVU24C |
| 2024-04-01 | $1,634.47 | $150.51 | RVU24B |
| 2024-03-09 | $1,634.47 | $150.51 | RVU24AR |
| 2024-01-01 | $1,607.79 | $148.06 | RVU24A |
| 2023-10-01 | $1,714.54 | $152.34 | RVU23D |
| 2023-07-01 | $1,714.54 | $152.34 | RVU23C |
| 2023-04-01 | $1,714.54 | $152.34 | RVU23B |
| 2023-01-01 | $1,714.54 | $152.34 | RVU23A |
| 2022-10-01 | $1,786.65 | $152.89 | RVU22D |
| 2022-07-01 | $1,786.65 | $152.89 | RVU22C |
| 2022-04-01 | $1,786.65 | $152.89 | RVU22B |
| 2022-01-01 | $1,786.65 | $152.89 | RVU22A |
| 2021-10-01 | $1,924.68 | $152.12 | RVU21D |
| 2021-07-01 | $1,924.68 | $152.12 | RVU21C |
| 2021-04-01 | $1,924.68 | $152.12 | RVU21B |
| 2021-01-01 | $1,924.68 | $152.12 | RVU21A |
| 2020-10-01 | $1,925.36 | $156.25 | RVU20D |
| 2020-07-01 | $1,925.36 | $156.25 | RVU20C |
| 2020-04-01 | $1,925.36 | $156.25 | RVU20B |
| 2020-01-01 | $1,925.36 | $156.25 | RVU20A |
| 2019-10-01 | $1,998.39 | $157.51 | RVU19D |
| 2019-07-01 | $1,998.39 | $157.51 | RVU19C |
| 2019-04-01 | $1,998.39 | $157.51 | RVU19B |
| 2019-01-01 | $1,998.39 | $157.51 | RVU19A |
| 2018-10-01 | $2,048.20 | $156.43 | RVU18D |
| 2018-07-01 | $2,048.20 | $156.43 | RVU18C |
| 2018-04-01 | $2,048.20 | $156.43 | RVU18B |
| 2018-01-01 | $2,048.20 | $156.43 | RVU18AR1 |
| 2017-10-01 | $2,050.44 | $161.98 | RVU17D |
| 2017-07-01 | $2,050.44 | $161.98 | RVU17C |
| 2017-04-01 | $2,050.44 | $161.98 | RVU17B |
| 2017-01-01 | $2,050.44 | $161.98 | RVU17A |
| 2016-10-01 | $2,083.67 | $163.48 | RVU16D |
| 2016-07-01 | $2,083.67 | $163.48 | RVU16C |
| 2016-04-01 | $2,083.67 | $163.48 | RVU16B |
| 2016-01-01 | $2,083.67 | $163.48 | RVU16A |
| 2015-10-01 | $2,091.03 | $166.79 | RVU15D |
| 2015-07-01 | $2,091.03 | $166.79 | RVU15C |
| 2015-04-01 | $2,080.62 | $165.96 | RVU15B |
| 2015-01-01 | $2,080.62 | $165.96 | RVU15A |
| 2014-10-01 | $2,098.75 | $166.46 | RVU14D |
| 2014-07-01 | $2,098.75 | $166.46 | RVU14C |
| 2014-04-01 | $2,098.75 | $166.46 | RVU14B |
| 2014-01-01 | $2,098.75 | $166.46 | RVU14A |
| 2013-10-01 | $2,224.12 | $163.68 | RVU13D |
| 2013-07-01 | $2,224.12 | $163.68 | RVU13C |
| 2013-04-01 | $2,224.12 | $163.68 | RVU13B |
| 2013-01-01 | $2,224.12 | $163.68 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
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
Show the CMS file lines behind this rate
Fee sheets · Coming soon
Put 31295 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist