FeeBase
Log inGet started
Menu

CPT code 31578: Laryngoscopy, flexible scope, lesion removal2026 Medicare rate & RVUs in Puerto Rico

Reports flexible endoscopic removal of a laryngeal lesion, such as a vocal fold lesion, when the physician physically removes it through the scope.

CMS RVU26DEffective Oct 1, 2026One payment locality26 Medicare services in 2024

In Puerto Rico, Medicare pays $306.45 for 31578 in the office and $129.50 when it’s performed in a hospital or facility.

$306.45Office (non-facility)
$129.50Hospital or facility
+0.7%vs the national office rate ($304.28)

Check a contract rate as a % of Medicare · 31578 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 31578 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Puerto Rico
  2. What 31578 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 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.

How Puerto Rico compares for 31578

Across 109 of 109 payment localities, the office rate for 31578 runs from $268.40 in Arkansas to $401.60 in San Benito County, CA. Puerto Rico pays $306.45. The RVUs are the same everywhere; the geographic indexes change the dollars.

31578 in Puerto Rico vs other payment areas
  1. Puerto Rico · this page$306.45
  2. Los Angeles, CA · California$342.48+$36.03
  3. Washington, DC area · District of Columbia$347.85+$41.40
  4. Miami, FL · Florida$331.40+$24.95
  5. Chicago, IL · Illinois$321.47+$15.02
  6. Manhattan, NY · New York$350.92+$44.47
  7. Alaska · Alaska$352.31+$45.86

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

Every other payment area

31578 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$272.43$119.28
ArkansasArkansas$268.40$118.06
ArizonaArizona$295.94$126.35
Bakersfield, CACalifornia$321.54$129.72
Chico, CACalifornia$320.51$128.68
El Centro, CACalifornia$320.57$128.74
Fresno, CACalifornia$320.51$128.68
Hanford, CACalifornia$320.51$128.68

31578 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.

$268.40

$361.06

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
31578 office rate range by state
State / territoryOffice rate rangeLocalities
AK$352.311
AL$272.431
AR$268.401
AZ$295.941
CA$320.51–$401.6029
CO$316.241
CT$324.801
DC$347.851
DE$300.911
FL$300.95–$331.403
GA$283.58–$310.352
GU$328.411
HI$328.411
IA$278.921
ID$280.901
IL$292.51–$321.474
IN$282.551
KS$277.861
KY$279.611
LA$279.27–$293.342
MA$314.40–$347.552
MD$306.64–$347.853
ME$282.69–$297.932
MI$287.29–$305.072
MN$302.001
MO$274.56–$294.083
MS$271.521
MT$304.261
NC$285.661
ND$297.141
NE$280.391
NH$311.521
NJ$328.22–$344.182
NM$289.011
NV$302.491
NY$290.06–$359.935
OH$285.841
OK$278.801
OR$299.86–$326.122
PA$286.15–$316.762
PR$306.451
RI$311.521
SC$286.281
SD$296.301
TN$279.321
TX$284.25–$315.438
UT$290.271
VA$297.12–$347.852
VI$306.451
VT$296.211
WA$313.73–$354.412
WI$287.011
WV$281.551
WY$301.161

See 31578 in every payment locality

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

Office or facility?

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.

The exact Puerto Rico inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

3,611

Code
31578
Physician work
2.37
Practice expense
6.38
Malpractice
0.36

GPCI2026.csv

91

Locality
Puerto Rico
Physician work
1.000
Practice expense
1.011
Malpractice
0.985
Office calculation for 31578 in Puerto Rico
ComponentRVULocality factorAdjusted
Physician work2.37× 1.0002.3700
Practice expense6.38× 1.0116.4502
Malpractice0.36× 0.9850.3546
Total RVUs9.1748
Conversion factor× 33.4009

Office rate, Puerto Rico$306.45

Office: (2.37 × 1 + 6.38 × 1.011 + 0.36 × 0.985) × $33.4009 = $306.45

Facility: (2.37 × 1 + 1.14 × 1.011 + 0.36 × 0.985) × $33.4009 = $129.50

Open 31578 in the RVU calculator

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

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)0Not paid without supporting documentation.
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

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%).

When to use modifier 51

Codes related to 31578

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

Codes related to 31578
CodeHow it relatesOffice range, Puerto Rico
Same family
31575Laryngoscopy, flexible, diagnosticFlexible diagnostic laryngoscopy without the lesion-removal service.$128.21
31576Laryngeal biopsy, flexible endoscopic approachFlexible laryngoscopy with biopsy rather than lesion removal.$270.60
31577Laryngoscopy, foreign body removalFlexible laryngoscopy for removal of a foreign body.$280.88
Used instead
31572Laser laryngoscopy, flexible scope, lesion destructionFlexible endoscopic laser destruction or ablation of a lesion.$515.88
31545Vocal cord excision, with operating microscope or telescopeOperative vocal-cord lesion removal using a direct laryngoscopic approach.No office rate

How 31578 has changed in Puerto Rico

31578 · Office / nonfacility

$306.45

Effective 2026-10-01

The base rate is $11.20 higher than on 2025-10-01, moving from $295.25 to $306.45 (3.8%).

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

    $295.25changed to$306.45

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.43 changed to 2.37
    • Practice expense RVU 6.30 changed to 6.38
    • Practice expense GPCI 1.007 changed to 1.011
    • Malpractice GPCI 0.982 changed to 0.985

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $308.19changed to$295.25

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 6.43 changed to 6.30

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $303.16changed to$308.19

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $314.68changed to$303.16

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 6.46 changed to 6.43
    • Malpractice RVU 0.35 changed to 0.36
    • Practice expense GPCI 1.008 changed to 1.007
    • Malpractice GPCI 0.984 changed to 0.982

  5. October 1, 2023

    RVU23D

    $313.12changed to$314.68

    • Practice expense GPCI 1.000 changed to 1.008
    • Malpractice GPCI 1.000 changed to 0.984

  6. January 1, 2023

    RVU23A

    $318.60changed to$313.12

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 6.39 changed to 6.46
    • Malpractice RVU 0.34 changed to 0.35
    • Practice expense GPCI 1.008 changed to 1.000
    • Malpractice GPCI 0.986 changed to 1.000

    Held through RVU23B, RVU23C.

  7. January 1, 2022

    RVU22A

    $313.16changed to$318.60

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 6.18 changed to 6.39
    • Malpractice RVU 0.32 changed to 0.34

    Held through RVU22B, RVU22C, RVU22D.

  8. January 1, 2021

    RVU21A

    $311.92changed to$313.16

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 5.85 changed to 6.18
    • Malpractice GPCI 0.988 changed to 0.986

    Held through RVU21B, RVU21C, RVU21D.

  9. January 1, 2020

    RVU20A

    $310.92changed to$311.92

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 5.81 changed to 5.85
    • Malpractice RVU 0.35 changed to 0.32
    • Practice expense GPCI 1.007 changed to 1.008
    • Malpractice GPCI 0.990 changed to 0.988

    Held through RVU20B, RVU20C, RVU20D.

  10. January 1, 2019

    RVU19A

    $307.68changed to$310.92

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.74 changed to 5.81
    • Malpractice RVU 0.34 changed to 0.35

    Held through RVU19B, RVU19C, RVU19D.

  11. January 1, 2018

    RVU18AR1

    $273.15changed to$307.68

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 5.79 changed to 5.74
    • Malpractice RVU 0.35 changed to 0.34
    • Practice expense GPCI 0.856 changed to 1.007
    • Malpractice GPCI 0.642 changed to 0.990

    Held through RVU18B, RVU18C, RVU18D.

  12. January 1, 2017

    RVU17A

    $226.14changed to$273.15

    • Conversion factor 35.8043 changed to 35.8887
    • Work RVU 2.84 changed to 2.43
    • Practice expense RVU 4.76 changed to 5.79
    • Malpractice RVU 0.41 changed to 0.35
    • Practice expense GPCI 0.705 changed to 0.856
    • Malpractice GPCI 0.293 changed to 0.642

    Held through RVU17B, RVU17C, RVU17D.

  13. January 1, 2016

    RVU16A

    $225.43changed to$226.14

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.70 changed to 4.76

    Held through RVU16B, RVU16C, RVU16D.

  14. July 1, 2015

    RVU15C

    $224.31changed to$225.43

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  15. January 1, 2015

    RVU15A

    $224.43changed to$224.31

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.82 changed to 4.70
    • Malpractice RVU 0.33 changed to 0.41
    • Practice expense GPCI 0.692 changed to 0.705
    • Malpractice GPCI 0.271 changed to 0.293

    Held through RVU15B.

  16. January 1, 2014

    RVU14A

    $223.00changed to$224.43

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.35 changed to 4.82
    • Malpractice RVU 0.35 changed to 0.33
    • Practice expense GPCI 0.678 changed to 0.692
    • Malpractice GPCI 0.249 changed to 0.271

    Held through RVU14B, RVU14C, RVU14D.

  17. January 1, 2013

    RVU13AR

    Earliest loaded release: $223.00

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$306.45$129.50RVU26D
2026-07-01$306.45$129.50RVU26C
2026-04-01$306.45$129.50RVU26B
2026-01-01$306.45$129.50RVU26A
2025-10-01$295.25$145.41RVU25D
2025-07-01$295.25$145.41RVU25C
2025-04-01$295.25$145.41RVU25B
2025-01-01$295.25$145.41RVU25A
2024-10-01$308.19$148.97RVU24D
2024-07-01$308.19$148.97RVU24C
2024-04-01$308.19$148.97RVU24B
2024-03-09$308.19$148.97RVU24AR
2024-01-01$303.16$146.54RVU24A
2023-10-01$314.68$150.72RVU23D
2023-07-01$313.12$150.46RVU23C
2023-04-01$313.12$150.46RVU23B
2023-01-01$313.12$150.46RVU23A
2022-10-01$318.60$150.81RVU22D
2022-07-01$318.60$150.81RVU22C
2022-04-01$318.60$150.81RVU22B
2022-01-01$318.60$150.81RVU22A
2021-10-01$313.16$148.21RVU21D
2021-07-01$313.16$148.21RVU21C
2021-04-01$313.16$148.21RVU21B
2021-01-01$313.16$148.21RVU21A
2020-10-01$311.92$152.22RVU20D
2020-07-01$311.92$152.22RVU20C
2020-04-01$311.92$152.22RVU20B
2020-01-01$311.92$152.22RVU20A
2019-10-01$310.92$154.14RVU19D
2019-07-01$310.92$154.14RVU19C
2019-04-01$310.92$154.14RVU19B
2019-01-01$310.92$154.14RVU19A
2018-10-01$307.68$152.89RVU18D
2018-07-01$307.68$152.89RVU18C
2018-04-01$307.68$152.89RVU18B
2018-01-01$307.68$152.89RVU18AR1
2017-10-01$273.15$141.97RVU17D
2017-07-01$273.15$141.97RVU17C
2017-04-01$273.15$141.97RVU17B
2017-01-01$273.15$141.97RVU17A
2016-10-01$226.14$149.91RVU16D
2016-07-01$226.14$149.91RVU16C
2016-04-01$226.14$149.91RVU16B
2016-01-01$226.14$149.91RVU16A
2015-10-01$225.43$149.94RVU15D
2015-07-01$225.43$149.94RVU15C
2015-04-01$224.31$149.19RVU15B
2015-01-01$224.31$149.19RVU15A
2014-10-01$224.43$149.07RVU14D
2014-07-01$224.43$149.07RVU14C
2014-04-01$224.43$149.07RVU14B
2014-01-01$224.43$149.07RVU14A
2013-10-01$223.00$144.57RVU13D
2013-07-01$223.00$144.57RVU13C
2013-04-01$223.00$144.57RVU13B
2013-01-01$223.00$144.57RVU13AR

Price 31578 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

  • Aceitunas
  • Adjuntas
  • Aguada
  • Aguadilla
  • Aguas Buenas
  • Aguas Claras
  • Aguilita
  • Aibonito

Browse all communities in Puerto Rico

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
RVUs for 31578PPRRVU2026_Oct_nonQPP.csv, line 3,611 (RVU26D)
Geographic factors for Puerto RicoGPCI2026.csv, line 91 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 31578 pays in Puerto Rico?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 31578 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist