CPT code 31535: Laryngeal biopsy, direct operative approach2026 Medicare rate & RVUs in Washington, DC area

Report direct operative laryngoscopy with biopsy when an otolaryngologist obtains tissue from a laryngeal lesion for diagnostic evaluation.

CMS RVU26DEffective Oct 1, 2026One payment locality4.9K Medicare services in 2024

In Washington, DC area, Medicare pays $177.10 for 31535 in a facility. There’s no office rate.

Not available in this settingOffice (non-facility)
$177.10Hospital or facility

Check a contract rate as a % of Medicare · 31535 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 31535 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 31535 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 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.

How Washington, DC area compares for 31535

Across 109 of 109 payment localities, the facility rate for 31535 runs from $148.49 in Arkansas to $209.55 in Alaska. Washington, DC area pays $177.10. The RVUs are the same everywhere; the geographic indexes change the dollars.

31535 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$177.10
  2. Los Angeles, CA · California$169.23−$7.87
  3. Miami, FL · Florida$186.78+$9.68
  4. Chicago, IL · Illinois$182.40+$5.30
  5. Manhattan, NY · New York$184.53+$7.43
  6. Alaska · Alaska$209.55+$32.45
  7. Alabama · Alabama$149.96−$27.14

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

31535 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas—$148.49
ArizonaArizona—$158.46
Bakersfield, CACalifornia—$162.30
Chico, CACalifornia—$161.00
El Centro, CACalifornia—$161.08
Fresno, CACalifornia—$161.00
Hanford, CACalifornia—$161.00
Madera, CACalifornia—$161.00

31535 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.

View every state and territory as a table
31535 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

See 31535 in every payment locality

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

Office or facility?

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.

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,590

Code
31535
Physician work
3.08
Practice expense
1.32
Malpractice
0.45

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Facility calculation for 31535 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work3.08× 1.0543.2463
Practice expense1.32× 1.1781.5550
Malpractice0.45× 1.1130.5009
Total RVUs5.3021
Conversion factor× 33.4009

Facility rate, Washington, DC area$177.10

Facility: (3.08 × 1.054 + 1.32 × 1.178 + 0.45 × 1.113) × $33.4009 = $177.10

Open 31535 in the RVU calculator

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

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)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician 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%).

When to use modifier 51

How 31535 has changed in Washington, DC area

31535 · Office / nonfacility

Rate unavailable

Effective 2026-10-01

A rate is unavailable in one of these releases, so a change cannot be calculated.

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
Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01Not available in this setting$177.10RVU26D
2026-07-01Not available in this setting$177.10RVU26C
2026-04-01Not available in this setting$177.10RVU26B
2026-01-01Not available in this setting$177.10RVU26A
2025-10-01Not available in this setting$205.22RVU25D
2025-07-01Not available in this setting$205.22RVU25C
2025-04-01Not available in this setting$205.22RVU25B
2025-01-01Not available in this setting$205.22RVU25A
2024-10-01Not available in this setting$209.22RVU24D
2024-07-01Not available in this setting$209.22RVU24C
2024-04-01Not available in this setting$209.22RVU24B
2024-03-09Not available in this setting$209.22RVU24AR
2024-01-01Not available in this setting$205.81RVU24A
2023-10-01Not available in this setting$213.71RVU23D
2023-07-01Not available in this setting$213.71RVU23C
2023-04-01Not available in this setting$213.71RVU23B
2023-01-01Not available in this setting$213.71RVU23A
2022-10-01Not available in this setting$217.09RVU22D
2022-07-01Not available in this setting$217.09RVU22C
2022-04-01Not available in this setting$217.09RVU22B
2022-01-01Not available in this setting$217.09RVU22A
2021-10-01Not available in this setting$216.32RVU21D
2021-07-01Not available in this setting$216.32RVU21C
2021-04-01Not available in this setting$216.32RVU21B
2021-01-01Not available in this setting$216.32RVU21A
2020-10-01Not available in this setting$218.79RVU20D
2020-07-01Not available in this setting$218.79RVU20C
2020-04-01Not available in this setting$218.79RVU20B
2020-01-01Not available in this setting$218.79RVU20A
2019-10-01Not available in this setting$218.06RVU19D
2019-07-01Not available in this setting$218.06RVU19C
2019-04-01Not available in this setting$218.06RVU19B
2019-01-01Not available in this setting$218.06RVU19A
2018-10-01Not available in this setting$217.86RVU18D
2018-07-01Not available in this setting$217.86RVU18C
2018-04-01Not available in this setting$217.86RVU18B
2018-01-01Not available in this setting$217.86RVU18AR1
2017-10-01Not available in this setting$219.41RVU17D
2017-07-01Not available in this setting$219.41RVU17C
2017-04-01Not available in this setting$219.41RVU17B
2017-01-01Not available in this setting$219.41RVU17A
2016-10-01Not available in this setting$221.54RVU16D
2016-07-01Not available in this setting$221.54RVU16C
2016-04-01Not available in this setting$221.54RVU16B
2016-01-01Not available in this setting$221.54RVU16A
2015-10-01Not available in this setting$222.36RVU15D
2015-07-01Not available in this setting$222.36RVU15C
2015-04-01Not available in this setting$221.26RVU15B
2015-01-01Not available in this setting$221.26RVU15A
2014-10-01Not available in this setting$218.80RVU14D
2014-07-01Not available in this setting$218.80RVU14C
2014-04-01Not available in this setting$218.80RVU14B
2014-01-01Not available in this setting$218.80RVU14A
2013-10-01Not available in this setting$214.14RVU13D
2013-07-01Not available in this setting$214.14RVU13C
2013-04-01Not available in this setting$214.14RVU13B
2013-01-01Not available in this setting$214.14RVU13AR

Price 31535 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

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
RVUs for 31535PPRRVU2026_Oct_nonQPP.csv, line 3,590 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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