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Billing code 31253: Sinus endoscopyMedicare rate & RVUs

Report this endoscopic sinus operation when the surgeon performs a total ethmoidectomy and explores the frontal sinus during the same procedure.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.4K Medicare services in 2024

Medicare pays $420.18 for 31253 nationally in a facility.

Medicare rate · 31253

Sinus endoscopy

Swap in your local Medicare rate.

Work RVUs
8.78
Total RVUs
12.58
Global days
000

National rate · 2026

$420.18

Facility setting, before claim adjustments.

See every locality for 31253 → · Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

On this page 10 sections
  1. Medicare rate
  2. What 31253 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 31253 covers

An otolaryngologist uses an endoscope through the nostril to remove ethmoid air cells as a total ethmoidectomy and access the frontal sinus. Frontal sinus tissue may also be removed when encountered. The operation is used for conditions such as chronic rhinosinusitis with obstructed frontal drainage or nasal polyps, and is typically performed in an operating room.

Select 31253 when the operative report supports both the total ethmoidectomy and frontal sinus exploration; document the work performed on each side. CMS applies endoscopy-family pricing when related endoscopies are performed together. For bilateral reporting, modifier 50 is paid at 150%. The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service; 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 31253 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

31253 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$391.00
Alaska*Unavailable$552.92
ArizonaUnavailable$411.38
ArkansasUnavailable$387.47
AtlantaUnavailable$431.07
AustinUnavailable$420.72
BakersfieldUnavailable$416.96
Baltimore/Surr. CntysUnavailable$441.21
BeaumontUnavailable$409.58
BrazoriaUnavailable$412.30

31253 rates by state

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

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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
31253 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

How the 31253 rate is calculated

Each of 31253’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 · 31253

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 8.78Practice expense 2.51Malpractice 1.29

12.5800 adjusted RVUs×$33.4009 conversion factor=$420.18

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 31253

The CMS indicators that decide how 31253 is paid alongside other services.

CMS payment indicators · 31253

Sinus endoscopy

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)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 50 · payment effect

With and without the modifier

31253 without 50 · national facility

$420.18

Sinus endoscopy

31253-50 · Bilateral: 150%

$630.27

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

31253 compared with similar codes

Compare codes

31253 vs 31255 vs 31276 vs 31257 vs 31254: national Medicare rates

Swap in your local Medicare rate.

  • 31253
    Sinus endoscopy · 8.78 wRVU
    —
  • 31255
    Ethmoidectomy · 5.61 wRVU
    —
  • 31276
    Frontal sinus endoscopy · 6.58 wRVU
    —
  • 31257
    Sinus endoscopy · 7.8 wRVU
    —
  • 31254
    Ethmoidectomy · 4.16 wRVU
    $436.55

How to choose

31255Ethmoidectomy
31255 describes total ethmoidectomy alone. Choose 31253 when the surgeon also explores the frontal sinus in the same operative service.
31276Frontal sinus endoscopy
31276 describes frontal sinus exploration without the total ethmoidectomy. When both procedures are performed, 31253 describes their combination.
31257Sinus endoscopy
31257 combines total ethmoidectomy with sphenoidotomy. 31253 pairs total ethmoidectomy with frontal sinus exploration instead.
31254Ethmoidectomy
31254 represents partial ethmoidectomy. 31253 requires total ethmoidectomy and also includes frontal sinus exploration.

Codes related to 31253

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

Codes related to 31253
CodeHow it relatesNational office range
Same family
31254EthmoidectomyEndoscopic partial ethmoidectomy; differs in the extent of ethmoid removal.$387.69–$565.22
Used instead
31255EthmoidectomyUsed for total ethmoidectomy without the frontal sinus exploration included in 31253.No office rate
31257Sinus endoscopyCombines total ethmoidectomy with sphenoidotomy rather than frontal sinus exploration.No office rate
31276Frontal sinus endoscopyFrontal sinus exploration without the total ethmoidectomy included in 31253.No office rate
31259Sinus endoscopyCombines total ethmoidectomy and sphenoidotomy with removal of sphenoid tissue.No office rate

31253 billing questions

When should 31253 be chosen instead of 31255?

Use 31253 when the surgeon performs a total ethmoidectomy and frontal sinus exploration. Code 31255 describes a total ethmoidectomy without the frontal sinus work.

Can 31255 or 31276 also be reported for the same operative work?

Do not separately report those codes for the total ethmoidectomy or frontal exploration already represented by 31253. CMS endoscopy-family pricing applies when related endoscopies are performed together.

How is bilateral 31253 reported?

Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%. Document the work performed on both sides.

Does 31253 have a postoperative global period?

It has a 0-day global period. Same-day preoperative and postoperative care is included.

Can an assistant surgeon or co-surgeon be paid for 31253?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery 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 31253PPRRVU2026_Oct_nonQPP.csv, line 3,534 (RVU26D)

Open CMS sourceHow we calculate rates

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