CPT code 31296: Sinus dilation, frontal sinus2026 Medicare rate & RVUs in South Dakota
Report this service for endoscopic dilation of a frontal sinus opening, commonly using a balloon to improve drainage without removing sinus tissue.
In South Dakota, Medicare pays $1,593.71 for 31296 in the office and $142.77 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 31296 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 31296 covers
An otolaryngologist typically performs this procedure by guiding an endoscope through the nose to the frontal sinus opening and dilating the ostium, often with a balloon catheter. It may be performed in an office or an operating room for a patient with frontal sinus drainage problems. The service is specific to the frontal sinus; dilation of a maxillary or sphenoid sinus is represented by a different site-specific code.
Report 31296 when the documented work is dilation of the frontal sinus ostium. The operative note should identify the treated sinus and side, describe the endoscopic dilation, and support the clinical need. It has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral treatment, modifier 50 is paid at 150%. An assistant at surgery may be paid; 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 South Dakota compares for 31296
Across 109 of 109 payment localities, the office rate for 31296 runs from $1,386.47 in Arkansas to $2,265.38 in San Benito County, CA. South Dakota pays $1,593.71. The RVUs are the same everywhere; the geographic indexes change the dollars.
- South Dakota · this page$1,593.71
- Los Angeles, CA · California$1,874.86+$281.15
- Washington, DC area · District of Columbia$1,875.18+$281.47
- Miami, FL · Florida$1,686.21+$92.50
- Chicago, IL · Illinois$1,629.99+$36.28
- Manhattan, NY · New York$1,859.17+$265.46
- Alaska · Alaska$1,743.95+$150.24
Other areas in South Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $1,411.01 | $141.44 |
| ArkansasArkansas | $1,386.47 | $140.11 |
| ArizonaArizona | $1,555.05 | $149.09 |
| Bakersfield, CACalifornia | $1,742.39 | $152.17 |
| Chico, CACalifornia | $1,741.14 | $150.92 |
| El Centro, CACalifornia | $1,741.21 | $150.99 |
| Fresno, CACalifornia | $1,741.14 | $150.92 |
| Hanford, CACalifornia | $1,741.14 | $150.92 |
| Madera, CACalifornia | $1,741.14 | $150.92 |
| Merced, CACalifornia | $1,741.14 | $150.92 |
| Modesto, CACalifornia | $1,741.14 | $150.92 |
| Napa, CACalifornia | $2,075.72 | $163.39 |
| Oxnard, CACalifornia | $1,871.47 | $156.47 |
| Redding, CACalifornia | $1,741.14 | $150.92 |
| Rest of CaliforniaCalifornia | $1,741.14 | $150.92 |
| Riverside, CACalifornia | $1,745.80 | $155.57 |
| Sacramento, CACalifornia | $1,842.76 | $155.32 |
| Salinas, CACalifornia | $1,836.30 | $154.67 |
| San Diego, CACalifornia | $1,891.34 | $156.02 |
| Marin County, CACalifornia | $2,215.14 | $169.32 |
| San Francisco, CACalifornia | $2,214.65 | $168.83 |
| San Benito County, CACalifornia | $2,265.38 | $173.13 |
| Santa Clara County, CACalifornia | $2,263.38 | $171.13 |
| San Luis Obispo, CACalifornia | $1,805.13 | $152.51 |
| Santa Cruz, CACalifornia | $1,918.62 | $155.73 |
| Santa Maria, CACalifornia | $1,846.41 | $154.62 |
| Santa Rosa, CACalifornia | $1,938.87 | $157.12 |
| Stockton, CACalifornia | $1,741.14 | $150.92 |
| Vallejo, CACalifornia | $2,075.02 | $162.68 |
| Visalia, CACalifornia | $1,741.14 | $150.92 |
| Yuba City, CACalifornia | $1,741.14 | $150.92 |
| ColoradoColorado | $1,696.54 | $152.75 |
| ConnecticutConnecticut | $1,722.85 | $160.20 |
| DelawareDelaware | $1,584.44 | $150.92 |
| Fort Lauderdale, FLFlorida | $1,634.19 | $164.39 |
| Rest of FloridaFlorida | $1,545.00 | $157.90 |
| Atlanta, GAGeorgia | $1,630.24 | $156.09 |
| Rest of GeorgiaGeorgia | $1,445.30 | $151.06 |
| Hawaii, Guam, HIHawaii | $1,801.05 | $151.34 |
| IowaIowa | $1,468.10 | $140.50 |
| IdahoIdaho | $1,476.63 | $141.77 |
| East St. Louis, ILIllinois | $1,498.77 | $163.91 |
| Rest of IllinoisIllinois | $1,481.87 | $157.17 |
| Suburban Chicago, ILIllinois | $1,655.21 | $165.10 |
| IndianaIndiana | $1,487.24 | $142.22 |
| KansasKansas | $1,453.27 | $141.63 |
| KentuckyKentucky | $1,436.85 | $146.97 |
| New Orleans, LALouisiana | $1,517.40 | $152.07 |
| Rest of LouisianaLouisiana | $1,431.52 | $147.44 |
| Metropolitan Boston, MAMassachusetts | $1,894.47 | $162.06 |
| Rest of MassachusettsMassachusetts | $1,680.81 | $152.97 |
| Baltimore area, MDMaryland | $1,716.89 | $160.03 |
| Rest of MarylandMaryland | $1,620.93 | $152.58 |
| Rest of MaineMaine | $1,478.77 | $143.91 |
| Southern Maine, MEMaine | $1,584.55 | $146.67 |
| Detroit, MIMichigan | $1,561.02 | $160.86 |
| Rest of MichiganMichigan | $1,475.64 | $150.94 |
| MinnesotaMinnesota | $1,636.28 | $143.27 |
| Metropolitan Kansas City, MOMissouri | $1,512.14 | $149.72 |
| Metropolitan St. Louis, MOMissouri | $1,531.85 | $150.56 |
| Rest of MissouriMissouri | $1,397.52 | $146.82 |
| MississippiMississippi | $1,392.66 | $143.41 |
| MontanaMontana | $1,603.21 | $152.28 |
| North CarolinaNorth Carolina | $1,498.36 | $144.64 |
| North DakotaNorth Dakota | $1,594.71 | $143.78 |
| NebraskaNebraska | $1,479.73 | $140.52 |
| New HampshireNew Hampshire | $1,662.46 | $152.03 |
| Northern New JerseyNew Jersey | $1,848.66 | $165.57 |
| Rest of New JerseyNew Jersey | $1,745.57 | $161.15 |
| New MexicoNew Mexico | $1,482.63 | $152.12 |
| NevadaNevada | $1,602.33 | $149.95 |
| NYC suburbs and Long Island, NYNew York | $1,903.24 | $178.08 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $1,752.16 | $163.39 |
| Queens, NYNew York | $1,886.86 | $171.86 |
| Rest of New YorkNew York | $1,524.58 | $146.19 |
| OhioOhio | $1,473.90 | $149.20 |
| OklahomaOklahoma | $1,440.82 | $145.14 |
| Portland, OROregon | $1,766.35 | $154.36 |
| Rest of OregonOregon | $1,593.03 | $147.89 |
| Metropolitan Philadelphia, PAPennsylvania | $1,668.84 | $158.42 |
| Rest of PennsylvaniaPennsylvania | $1,480.44 | $148.48 |
| Puerto RicoPuerto Rico | $1,619.40 | $152.50 |
| Rhode IslandRhode Island | $1,652.71 | $153.90 |
| South CarolinaSouth Carolina | $1,488.00 | $147.34 |
| TennesseeTennessee | $1,461.18 | $142.28 |
| Austin, TXTexas | $1,688.11 | $153.02 |
| Beaumont, TXTexas | $1,468.30 | $147.95 |
| Brazoria, TXTexas | $1,587.50 | $149.62 |
| Dallas, TXTexas | $1,596.16 | $151.03 |
| Fort Worth, TXTexas | $1,581.47 | $150.84 |
| Galveston, TXTexas | $1,591.16 | $150.39 |
| Houston, TXTexas | $1,599.03 | $158.26 |
| Rest of TexasTexas | $1,525.96 | $149.02 |
| UtahUtah | $1,512.50 | $148.62 |
| VirginiaVirginia | $1,573.72 | $147.46 |
| Virgin Islands, VIUnited States Virgin Islands | $1,619.40 | $152.50 |
| VermontVermont | $1,581.27 | $144.84 |
| Rest of WashingtonWashington | $1,679.99 | $152.15 |
| King County, WAWashington | $1,943.44 | $163.14 |
| WisconsinWisconsin | $1,530.81 | $140.81 |
| West VirginiaWest Virginia | $1,414.50 | $153.64 |
| WyomingWyoming | $1,599.51 | $148.57 |
31296 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.
$1,386.47
$2,003.26
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 | $1,743.95 | 1 |
| AL | $1,411.01 | 1 |
| AR | $1,386.47 | 1 |
| AZ | $1,555.05 | 1 |
| CA | $1,741.14–$2,265.38 | 29 |
| CO | $1,696.54 | 1 |
| CT | $1,722.85 | 1 |
| DC | $1,875.18 | 1 |
| DE | $1,584.44 | 1 |
| FL | $1,545.00–$1,686.21 | 3 |
| GA | $1,445.30–$1,630.24 | 2 |
| GU | $1,801.05 | 1 |
| HI | $1,801.05 | 1 |
| IA | $1,468.10 | 1 |
| ID | $1,476.63 | 1 |
| IL | $1,481.87–$1,655.21 | 4 |
| IN | $1,487.24 | 1 |
| KS | $1,453.27 | 1 |
| KY | $1,436.85 | 1 |
| LA | $1,431.52–$1,517.40 | 2 |
| MA | $1,680.81–$1,894.47 | 2 |
| MD | $1,620.93–$1,875.18 | 3 |
| ME | $1,478.77–$1,584.55 | 2 |
| MI | $1,475.64–$1,561.02 | 2 |
| MN | $1,636.28 | 1 |
| MO | $1,397.52–$1,531.85 | 3 |
| MS | $1,392.66 | 1 |
| MT | $1,603.21 | 1 |
| NC | $1,498.36 | 1 |
| ND | $1,594.71 | 1 |
| NE | $1,479.73 | 1 |
| NH | $1,662.46 | 1 |
| NJ | $1,745.57–$1,848.66 | 2 |
| NM | $1,482.63 | 1 |
| NV | $1,602.33 | 1 |
| NY | $1,524.58–$1,903.24 | 5 |
| OH | $1,473.90 | 1 |
| OK | $1,440.82 | 1 |
| OR | $1,593.03–$1,766.35 | 2 |
| PA | $1,480.44–$1,668.84 | 2 |
| PR | $1,619.40 | 1 |
| RI | $1,652.71 | 1 |
| SC | $1,488.00 | 1 |
| SD | $1,593.71 | 1 |
| TN | $1,461.18 | 1 |
| TX | $1,468.30–$1,688.11 | 8 |
| UT | $1,512.50 | 1 |
| VA | $1,573.72–$1,875.18 | 2 |
| VI | $1,619.40 | 1 |
| VT | $1,581.27 | 1 |
| WA | $1,679.99–$1,943.44 | 2 |
| WI | $1,530.81 | 1 |
| WV | $1,414.50 | 1 |
| WY | $1,599.51 | 1 |
How the 31296 rate is calculated
Each of 31296’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 · 31296
RVUs × geographic indexes × conversion factor
Work3.02
3.02 RVUs× 1.000 GPCI
Practice expense44.55
44.55 RVUs× 1.000 GPCI
Malpractice0.43
0.43 RVUs× 1.000 GPCI
Adjusted RVUs
48.0000
Conversion factor
$33.4009
Medicare rate
$1,603.24
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact South Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
3,551
- Code
- 31296
- Physician work
- 3.02
- Practice expense
- 44.55
- Malpractice
- 0.43
GPCI2026.csv
94
- Locality
- South Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.336
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.02 | × 1.000 | 3.0200 |
| Practice expense | 44.55 | × 1.000 | 44.5500 |
| Malpractice | 0.43 | × 0.336 | 0.1445 |
| Total RVUs | 47.7145 | ||
| Conversion factor | × 33.4009 | ||
Office rate, South Dakota$1593.71
Office: (3.02 × 1 + 44.55 × 1 + 0.43 × 0.336) × $33.4009 = $1593.71
Facility: (3.02 × 1 + 1.11 × 1 + 0.43 × 0.336) × $33.4009 = $142.77
Payment rules and modifiers for 31296
The CMS indicators that decide how 31296 is paid alongside other services.
CMS payment indicators · 31296
Sinus dilation, frontal sinus
| 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
31296 without 50 · national office
$1,603.24
Sinus dilation, frontal sinus
31296-50 · Bilateral: 150%
$2,404.86
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 31296 has changed in South Dakota
31296 · Office / nonfacility
$1593.71
Effective 2026-10-01
The base rate is $55.65 higher than on 2025-10-01, moving from $1538.06 to $1593.71 (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
$1538.06changed to$1593.71
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 3.10 changed to 3.02
- Practice expense RVU 44.27 changed to 44.55
- Malpractice RVU 0.47 changed to 0.43
- Malpractice GPCI 0.382 changed to 0.336
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$1656.65changed to$1538.06
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 46.50 changed to 44.27
- Malpractice RVU 0.44 changed to 0.47
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$1629.62changed to$1656.65
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$1737.74changed to$1629.62
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 48.02 changed to 46.50
- Malpractice GPCI 0.364 changed to 0.382
January 1, 2023
RVU23A
$1810.10changed to$1737.74
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 49.06 changed to 48.02
- Malpractice RVU 0.42 changed to 0.44
- Malpractice GPCI 0.347 changed to 0.364
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$1948.40changed to$1810.10
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 52.59 changed to 49.06
- Malpractice RVU 0.43 changed to 0.42
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$1948.77changed to$1948.40
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 50.74 changed to 52.59
- Malpractice GPCI 0.368 changed to 0.347
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$2021.47changed to$1948.77
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 52.82 changed to 50.74
- Malpractice RVU 0.44 changed to 0.43
- Malpractice GPCI 0.389 changed to 0.368
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$2070.88changed to$2021.47
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 54.25 changed to 52.82
- Malpractice RVU 0.45 changed to 0.44
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$2087.85changed to$2070.88
- Conversion factor 35.8887 changed to 35.9996
- Work RVU 3.29 changed to 3.10
- Practice expense RVU 54.70 changed to 54.25
- Malpractice RVU 0.47 changed to 0.45
- Malpractice GPCI 0.395 changed to 0.389
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$2120.40changed to$2087.85
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 55.74 changed to 54.70
- Malpractice RVU 0.48 changed to 0.47
- Malpractice GPCI 0.400 changed to 0.395
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$2116.56changed to$2120.40
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 55.42 changed to 55.74
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$2106.02changed to$2116.56
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$2127.39changed to$2106.02
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 55.93 changed to 55.42
- Malpractice RVU 0.40 changed to 0.48
- Malpractice GPCI 0.416 changed to 0.400
Held through RVU15B.
January 1, 2014
RVU14A
$2255.43changed to$2127.39
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 62.82 changed to 55.93
- Malpractice RVU 0.42 changed to 0.40
- Malpractice GPCI 0.432 changed to 0.416
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $2255.43
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1,593.71 | $142.77 | RVU26D |
| 2026-07-01 | $1,593.71 | $142.77 | RVU26C |
| 2026-04-01 | $1,593.71 | $142.77 | RVU26B |
| 2026-01-01 | $1,593.71 | $142.77 | RVU26A |
| 2025-10-01 | $1,538.06 | $165.60 | RVU25D |
| 2025-07-01 | $1,538.06 | $165.60 | RVU25C |
| 2025-04-01 | $1,538.06 | $165.60 | RVU25B |
| 2025-01-01 | $1,538.06 | $165.60 | RVU25A |
| 2024-10-01 | $1,656.65 | $169.04 | RVU24D |
| 2024-07-01 | $1,656.65 | $169.04 | RVU24C |
| 2024-04-01 | $1,656.65 | $169.04 | RVU24B |
| 2024-03-09 | $1,656.65 | $169.04 | RVU24AR |
| 2024-01-01 | $1,629.62 | $166.28 | RVU24A |
| 2023-10-01 | $1,737.74 | $171.47 | RVU23D |
| 2023-07-01 | $1,737.74 | $171.47 | RVU23C |
| 2023-04-01 | $1,737.74 | $171.47 | RVU23B |
| 2023-01-01 | $1,737.74 | $171.47 | RVU23A |
| 2022-10-01 | $1,810.10 | $172.19 | RVU22D |
| 2022-07-01 | $1,810.10 | $172.19 | RVU22C |
| 2022-04-01 | $1,810.10 | $172.19 | RVU22B |
| 2022-01-01 | $1,810.10 | $172.19 | RVU22A |
| 2021-10-01 | $1,948.40 | $171.65 | RVU21D |
| 2021-07-01 | $1,948.40 | $171.65 | RVU21C |
| 2021-04-01 | $1,948.40 | $171.65 | RVU21B |
| 2021-01-01 | $1,948.40 | $171.65 | RVU21A |
| 2020-10-01 | $1,948.77 | $176.05 | RVU20D |
| 2020-07-01 | $1,948.77 | $176.05 | RVU20C |
| 2020-04-01 | $1,948.77 | $176.05 | RVU20B |
| 2020-01-01 | $1,948.77 | $176.05 | RVU20A |
| 2019-10-01 | $2,021.47 | $176.63 | RVU19D |
| 2019-07-01 | $2,021.47 | $176.63 | RVU19C |
| 2019-04-01 | $2,021.47 | $176.63 | RVU19B |
| 2019-01-01 | $2,021.47 | $176.63 | RVU19A |
| 2018-10-01 | $2,070.88 | $175.86 | RVU18D |
| 2018-07-01 | $2,070.88 | $175.86 | RVU18C |
| 2018-04-01 | $2,070.88 | $175.86 | RVU18B |
| 2018-01-01 | $2,070.88 | $175.86 | RVU18AR1 |
| 2017-10-01 | $2,087.85 | $191.49 | RVU17D |
| 2017-07-01 | $2,087.85 | $191.49 | RVU17C |
| 2017-04-01 | $2,087.85 | $191.49 | RVU17B |
| 2017-01-01 | $2,087.85 | $191.49 | RVU17A |
| 2016-10-01 | $2,120.40 | $193.06 | RVU16D |
| 2016-07-01 | $2,120.40 | $193.06 | RVU16C |
| 2016-04-01 | $2,120.40 | $193.06 | RVU16B |
| 2016-01-01 | $2,120.40 | $193.06 | RVU16A |
| 2015-10-01 | $2,116.56 | $196.27 | RVU15D |
| 2015-07-01 | $2,116.56 | $196.27 | RVU15C |
| 2015-04-01 | $2,106.02 | $195.29 | RVU15B |
| 2015-01-01 | $2,106.02 | $195.29 | RVU15A |
| 2014-10-01 | $2,127.39 | $197.25 | RVU14D |
| 2014-07-01 | $2,127.39 | $197.25 | RVU14C |
| 2014-04-01 | $2,127.39 | $197.25 | RVU14B |
| 2014-01-01 | $2,127.39 | $197.25 | RVU14A |
| 2013-10-01 | $2,255.43 | $194.32 | RVU13D |
| 2013-07-01 | $2,255.43 | $194.32 | RVU13C |
| 2013-04-01 | $2,255.43 | $194.32 | RVU13B |
| 2013-01-01 | $2,255.43 | $194.32 | RVU13AR |
Where the South Dakota rate applies
South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.
- Aberdeen
- Agar
- Agency Village
- Akaska
- Albee
- Alcester
- Alexandria
- Allen
31296 billing questions
How is 31296 different from 31295 or 31297?
31296 is for dilation of the frontal sinus ostium. Codes 31295 and 31297 describe dilation at the maxillary and sphenoid sinuses, respectively.
When is modifier 50 appropriate?
Use modifier 50 when the frontal sinus dilation is performed bilaterally. CMS identifies bilateral payment at 150%.
Can 31296 be reported with another sinus endoscopy code?
Related endoscopies performed together are subject to endoscopy family pricing. The operative documentation should establish the distinct work and sinus sites treated.
Does the code include same-day postoperative care?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid for this procedure. Co-surgeons and team surgery are not permitted.
What should the operative note identify?
Document the frontal sinus side treated, the endoscopic dilation performed, and the clinical reason for opening the ostium. Distinguish dilation from procedures involving tissue removal.
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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