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CPT code 31296: Sinus dilation, frontal sinus2026 Medicare rate & RVUs in Vermont

Report this service for endoscopic dilation of a frontal sinus opening, commonly using a balloon to improve drainage without removing sinus tissue.

CMS RVU26DEffective Oct 1, 2026One payment locality5K Medicare services in 2024

In Vermont, Medicare pays $1,581.27 for 31296 in the office and $144.84 when it’s performed in a hospital or facility.

$1,581.27Office (non-facility)
$144.84Hospital or facility
−1.4%vs the national office rate ($1,603.24)

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.

We’ll open 31296 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Vermont
  2. What 31296 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 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 Vermont 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. Vermont pays $1,581.27. The RVUs are the same everywhere; the geographic indexes change the dollars.

31296 in Vermont vs other payment areas
  1. Vermont · this page$1,581.27
  2. Los Angeles, CA · California$1,874.86+$293.59
  3. Washington, DC area · District of Columbia$1,875.18+$293.91
  4. Miami, FL · Florida$1,686.21+$104.94
  5. Chicago, IL · Illinois$1,629.99+$48.72
  6. Manhattan, NY · New York$1,859.17+$277.90
  7. Alaska · Alaska$1,743.95+$162.68

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

Every other payment area

31296 in every other Medicare payment locality
Payment localityOfficeFacility
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

31296 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
31296 office rate range by state
State / territoryOffice rate rangeLocalities
AK$1,743.951
AL$1,411.011
AR$1,386.471
AZ$1,555.051
CA$1,741.14–$2,265.3829
CO$1,696.541
CT$1,722.851
DC$1,875.181
DE$1,584.441
FL$1,545.00–$1,686.213
GA$1,445.30–$1,630.242
GU$1,801.051
HI$1,801.051
IA$1,468.101
ID$1,476.631
IL$1,481.87–$1,655.214
IN$1,487.241
KS$1,453.271
KY$1,436.851
LA$1,431.52–$1,517.402
MA$1,680.81–$1,894.472
MD$1,620.93–$1,875.183
ME$1,478.77–$1,584.552
MI$1,475.64–$1,561.022
MN$1,636.281
MO$1,397.52–$1,531.853
MS$1,392.661
MT$1,603.211
NC$1,498.361
ND$1,594.711
NE$1,479.731
NH$1,662.461
NJ$1,745.57–$1,848.662
NM$1,482.631
NV$1,602.331
NY$1,524.58–$1,903.245
OH$1,473.901
OK$1,440.821
OR$1,593.03–$1,766.352
PA$1,480.44–$1,668.842
PR$1,619.401
RI$1,652.711
SC$1,488.001
SD$1,593.711
TN$1,461.181
TX$1,468.30–$1,688.118
UT$1,512.501
VA$1,573.72–$1,875.182
VI$1,619.401
VT$1,581.271
WA$1,679.99–$1,943.442
WI$1,530.811
WV$1,414.501
WY$1,599.511

See 31296 in every payment locality

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

Office or facility?

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 Vermont 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

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Office calculation for 31296 in Vermont
ComponentRVULocality factorAdjusted
Physician work3.02× 1.0003.0200
Practice expense44.55× 0.99044.1045
Malpractice0.43× 0.5060.2176
Total RVUs47.3421
Conversion factor× 33.4009

Office rate, Vermont$1581.27

Office: (3.02 × 1 + 44.55 × 0.99 + 0.43 × 0.506) × $33.4009 = $1581.27

Facility: (3.02 × 1 + 1.11 × 0.99 + 0.43 × 0.506) × $33.4009 = $144.84

Open 31296 in the RVU calculator

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

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is 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)2Paid.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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).

When to use modifier 50

Codes related to 31296

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

Codes related to 31296
CodeHow it relatesOffice range, Vermont
Same family
31295Sinus dilation, maxillary sinus ostiumRelated endoscopic dilation code for the maxillary sinus.$1,556.32
31297Sinus dilation, sphenoid ostiumRelated endoscopic dilation code for the sphenoid sinus.$1,543.83
31298Sinus dilation, frontal and sphenoidCombines endoscopic dilation of frontal and sphenoid sinus openings.$2,927.45
Used instead
31276Frontal sinus endoscopy, tissue removal when performedFrontal sinus endoscopy involving exploration and tissue removal rather than ostial dilation.No office rate

How 31296 has changed in Vermont

31296 · Office / nonfacility

$1581.27

Effective 2026-10-01

The base rate is $51.17 higher than on 2025-10-01, moving from $1530.10 to $1581.27 (3.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

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

  1. January 1, 2026

    RVU26A

    $1530.10changed to$1581.27

    • 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
    • Practice expense GPCI 0.993 changed to 0.990
    • Malpractice GPCI 0.518 changed to 0.506

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $1647.81changed to$1530.10

    • 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.

  3. March 9, 2024

    RVU24AR

    $1620.92changed to$1647.81

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $1735.53changed to$1620.92

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 48.02 changed to 46.50
    • Practice expense GPCI 0.997 changed to 0.993
    • Malpractice GPCI 0.543 changed to 0.518

  5. January 1, 2023

    RVU23A

    $1815.03changed to$1735.53

    • 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
    • Practice expense GPCI 1.001 changed to 0.997
    • Malpractice GPCI 0.569 changed to 0.543

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $1953.57changed to$1815.03

    • 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.

  7. January 1, 2021

    RVU21A

    $1966.75changed to$1953.57

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 50.74 changed to 52.59
    • Practice expense GPCI 1.008 changed to 1.001
    • Malpractice GPCI 0.582 changed to 0.569

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $2053.30changed to$1966.75

    • 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
    • Practice expense GPCI 1.015 changed to 1.008
    • Malpractice GPCI 0.595 changed to 0.582

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $2103.51changed to$2053.30

    • 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.

  10. January 1, 2018

    RVU18AR1

    $2111.60changed to$2103.51

    • 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
    • Practice expense GPCI 1.010 changed to 1.015
    • Malpractice GPCI 0.639 changed to 0.595

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $2133.23changed to$2111.60

    • 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
    • Practice expense GPCI 1.004 changed to 1.010
    • Malpractice GPCI 0.682 changed to 0.639

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $2129.38changed to$2133.23

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 55.42 changed to 55.74

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $2118.79changed to$2129.38

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $2142.30changed to$2118.79

    • 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
    • Practice expense GPCI 1.006 changed to 1.004
    • Malpractice GPCI 0.618 changed to 0.682

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    No ratechanged to$2142.30

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$1,581.27$144.84RVU26D
2026-07-01$1,581.27$144.84RVU26C
2026-04-01$1,581.27$144.84RVU26B
2026-01-01$1,581.27$144.84RVU26A
2025-10-01$1,530.10$167.25RVU25D
2025-07-01$1,530.10$167.25RVU25C
2025-04-01$1,530.10$167.25RVU25B
2025-01-01$1,530.10$167.25RVU25A
2024-10-01$1,647.81$170.61RVU24D
2024-07-01$1,647.81$170.61RVU24C
2024-04-01$1,647.81$170.61RVU24B
2024-03-09$1,647.81$170.61RVU24AR
2024-01-01$1,620.92$167.82RVU24A
2023-10-01$1,735.53$173.96RVU23D
2023-07-01$1,735.53$173.96RVU23C
2023-04-01$1,735.53$173.96RVU23B
2023-01-01$1,735.53$173.96RVU23A
2022-10-01$1,815.03$175.48RVU22D
2022-07-01$1,815.03$175.48RVU22C
2022-04-01$1,815.03$175.48RVU22B
2022-01-01$1,815.03$175.48RVU22A
2021-10-01$1,953.57$175.04RVU21D
2021-07-01$1,953.57$175.04RVU21C
2021-04-01$1,953.57$175.04RVU21B
2021-01-01$1,953.57$175.04RVU21A
2020-10-01$1,966.75$179.84RVU20D
2020-07-01$1,966.75$179.84RVU20C
2020-04-01$1,966.75$179.84RVU20B
2020-01-01$1,966.75$179.84RVU20A
2019-10-01$2,053.30$180.78RVU19D
2019-07-01$2,053.30$180.78RVU19C
2019-04-01$2,053.30$180.78RVU19B
2019-01-01$2,053.30$180.78RVU19A
2018-10-01$2,103.51$180.07RVU18D
2018-07-01$2,103.51$180.07RVU18C
2018-04-01$2,103.51$180.07RVU18B
2018-01-01$2,103.51$180.07RVU18AR1
2017-10-01$2,111.60$196.27RVU17D
2017-07-01$2,111.60$196.27RVU17C
2017-04-01$2,111.60$196.27RVU17B
2017-01-01$2,111.60$196.27RVU17A
2016-10-01$2,133.23$198.18RVU16D
2016-07-01$2,133.23$198.18RVU16C
2016-04-01$2,133.23$198.18RVU16B
2016-01-01$2,133.23$198.18RVU16A
2015-10-01$2,129.38$201.42RVU15D
2015-07-01$2,129.38$201.42RVU15C
2015-04-01$2,118.79$200.42RVU15B
2015-01-01$2,118.79$200.42RVU15A
2014-10-01$2,142.30$200.59RVU14D
2014-07-01$2,142.30$200.59RVU14C
2014-04-01$2,142.30$200.59RVU14B
2014-01-01$2,142.30$200.59RVU14A
2013-10-01Rate data unavailableRate data unavailableRVU13D
2013-07-01Rate data unavailableRate data unavailableRVU13C
2013-04-01Rate data unavailableRate data unavailableRVU13B
2013-01-01Rate data unavailableRate data unavailableRVU13AR

Price 31296 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

  • Albany
  • Alburgh
  • Algiers
  • Arlington
  • Ascutney
  • Bakersfield
  • Barnet
  • Barre

Browse all communities in Vermont

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

Show the CMS file lines behind this rate
RVUs for 31296PPRRVU2026_Oct_nonQPP.csv, line 3,551 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)

Open CMS sourceHow we calculate rates

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