CPT code 31535: Laryngeal biopsy, direct operative approach2026 Medicare rate & RVUs in California
Report direct operative laryngoscopy with biopsy when an otolaryngologist obtains tissue from a laryngeal lesion for diagnostic evaluation.
CMS doesn’t publish an office rate for 31535 in California.
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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What 31535 covers
An otolaryngologist performs a direct operative examination of the larynx and takes a tissue sample from a lesion or abnormal area for diagnostic evaluation. The service is commonly performed in an operating room, often under anesthesia, when a lesion needs tissue diagnosis. Examples include sampling a suspicious vocal fold or other laryngeal lesion; the code reflects biopsy, not complete removal of the lesion.
Select this code when the operative service includes direct laryngoscopy and tissue sampling. The operative report should identify the laryngeal site, describe the lesion and approach, and document that tissue was obtained. CMS assigns a zero-day global period, so same-day preoperative and postoperative care is included. Endoscopy-family pricing applies when related endoscopies are performed together. Modifier 50 is inappropriate. Medicare does not pay 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 31535 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $162.30 |
| Chico, CA | Unavailable | $161.00 |
| El Centro, CA | Unavailable | $161.08 |
| Fresno, CA | Unavailable | $161.00 |
| Hanford, CA | Unavailable | $161.00 |
| Los Angeles, CA | Unavailable | $169.23 |
| Madera, CA | Unavailable | $161.00 |
| Marin County, CA | Unavailable | $181.71 |
| Merced, CA | Unavailable | $161.00 |
| Modesto, CA | Unavailable | $161.00 |
| Napa, CA | Unavailable | $175.10 |
| Oxnard, CA | Unavailable | $167.23 |
| Redding, CA | Unavailable | $161.00 |
| Rest of California | Unavailable | $161.00 |
| Riverside, CA | Unavailable | $165.87 |
| Sacramento, CA | Unavailable | $165.91 |
| Salinas, CA | Unavailable | $165.22 |
| San Benito County, CA | Unavailable | $185.82 |
| San Diego, CA | Unavailable | $166.84 |
| San Francisco, CA | Unavailable | $181.20 |
| San Luis Obispo, CA | Unavailable | $162.90 |
| Santa Clara County, CA | Unavailable | $183.73 |
| Santa Cruz, CA | Unavailable | $166.66 |
| Santa Maria, CA | Unavailable | $165.22 |
| Santa Rosa, CA | Unavailable | $168.16 |
| Stockton, CA | Unavailable | $161.00 |
| Vallejo, CA | Unavailable | $174.36 |
| Visalia, CA | Unavailable | $161.00 |
| Yuba City, CA | Unavailable | $161.00 |
How the 31535 rate is calculated
Each of 31535’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 · 31535
RVUs × geographic indexes × conversion factor
Work3.08
3.08 RVUs× 1.000 GPCI
Practice expense1.32
1.32 RVUs× 1.000 GPCI
Malpractice0.45
0.45 RVUs× 1.000 GPCI
Adjusted RVUs
4.8500
Conversion factor
$33.4009
Medicare rate
$161.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31535
The CMS indicators that decide how 31535 is paid alongside other services.
CMS payment indicators · 31535
Laryngeal biopsy, direct operative approach
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| 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 51 · payment effect
With and without the modifier
31535 without 51 · national facility
$161.99
Laryngeal biopsy, direct operative approach
31535-51 · Second procedure: 50%
$81.00
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
31535 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31536Laryngeal biopsyWith operating scope
- Both describe direct operative laryngoscopy with biopsy. Choose 31536 when the documented procedure uses an operating microscope or telescope.
- 31540Laryngeal excisionWithout operating scope
- 31535 reports biopsy sampling for diagnosis; 31540 applies when the operative service excises a laryngeal lesion or tumor.
- 31525LaryngoscopyDiagnostic, except newborn
- 31525 is direct diagnostic laryngoscopy without tissue sampling. Report 31535 when a biopsy is obtained during the operative examination.
- 31510LaryngoscopyIndirect approach with biopsy
- 31510 describes biopsy by indirect laryngoscopy. 31535 is for the direct operative approach.
31535 billing questions
When should 31535 be chosen over 31536?
Use 31535 for direct operative laryngoscopy with biopsy without the operating microscope or telescope distinction. Use 31536 when the documented procedure includes an operating microscope or telescope.
How does a biopsy differ from laryngeal lesion excision?
31535 describes taking tissue for diagnosis. When the operative service removes or excises the lesion rather than sampling it, consider 31540 or the applicable related excision code.
Can diagnostic laryngoscopy be billed separately with the biopsy?
The direct examination is part of the operative laryngoscopy with biopsy. Do not separately report a diagnostic laryngoscopy for the same examination.
How should related endoscopies performed in the same session be handled?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The operative record should support each distinct service reported.
Can modifier 50 or an assistant-at-surgery claim be used?
Modifier 50 is inappropriate for this code. Medicare does not pay an assistant at surgery, and co-surgeon and team-surgery billing are not permitted.
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
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