CPT code 31578: Laryngoscopy, flexible scope, lesion removal2026 Medicare rate & RVUs in Michigan
Reports flexible endoscopic removal of a laryngeal lesion, such as a vocal fold lesion, when the physician physically removes it through the scope.
Medicare pays $287.29–$305.07 for 31578 in the office in Michigan, from Rest of Michigan to Detroit, MI. Which amount applies depends on the service address.
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 31578 covers
An otolaryngologist typically performs this procedure using a flexible laryngoscope to visualize the larynx and remove a lesion through the scope. It may be performed in an office or facility when the lesion can be reached and treated with the flexible endoscopic approach. The service involves removal, not simply inspection or tissue sampling; the operative note should identify the lesion, its laryngeal location, the removal technique, and the result.
Report this code when the physician removes a lesion using flexible laryngoscopy; use a biopsy, laser-treatment, or foreign-body code when that is the service performed instead. Documentation should support the therapeutic work rather than diagnostic visualization alone. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; 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 31578 pays more and less in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | $305.07 | $136.18 |
| Rest of Michigan | $287.29 | $127.50 |
How the 31578 rate is calculated
Each of 31578’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 · 31578
RVUs × geographic indexes × conversion factor
Work2.37
2.37 RVUs× 1.000 GPCI
Practice expense6.38
6.38 RVUs× 1.000 GPCI
Malpractice0.36
0.36 RVUs× 1.000 GPCI
Adjusted RVUs
9.1100
Conversion factor
$33.4009
Medicare rate
$304.28
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31578
The CMS indicators that decide how 31578 is paid alongside other services.
CMS payment indicators · 31578
Laryngoscopy, flexible scope, lesion removal
| 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) | 0 | Not paid without supporting documentation. |
| 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
31578 without 51 · national office
$304.28
Laryngoscopy, flexible scope, lesion removal
31578-51 · Second procedure: 50%
$152.14
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%).
31578 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31576Laryngeal biopsyFlexible endoscopic approach
- 31576 is for flexible laryngoscopy with tissue sampling for biopsy. Choose 31578 when the physician removes the lesion rather than merely sampling it.
- 31572Laser laryngoscopyFlexible scope, lesion destruction
- 31572 describes laser destruction or ablation of a lesion. This code is for physical lesion removal through flexible laryngoscopy.
- 31545Vocal cord excisionWith operating microscope or telescope
- 31545 is an operative direct-laryngoscopy approach for vocal-cord lesion removal. This code describes removal with a flexible scope.
- 31577LaryngoscopyForeign body removal
- 31577 is for removal of a foreign body from the larynx using flexible laryngoscopy, not removal of a laryngeal lesion.
31578 billing questions
How does this differ from flexible laryngoscopy with biopsy?
Use 31578 when the lesion is removed. Use 31576 when the physician obtains tissue for biopsy rather than removing the lesion as the therapeutic service.
Can diagnostic laryngoscopy be reported separately?
The visualization is part of the lesion-removal service. Do not separately report diagnostic laryngoscopy for the same examination.
When is the laser lesion code a better fit?
Use 31572 when the lesion is destroyed or ablated with a laser. This code describes physical removal through flexible laryngoscopy.
Should modifier 50 be appended for lesions on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.
What should the operative note describe?
Document the lesion's laryngeal location, the flexible endoscopic approach, how the lesion was removed, and the outcome. The record should distinguish removal from biopsy, laser destruction, or foreign-body extraction.
How are related endoscopies handled when performed together?
CMS endoscopy-family pricing applies when related endoscopies are performed together. The code has a 0-day global period, including same-day preoperative and postoperative care.
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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