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Billing code 31255: EthmoidectomyMedicare rate & RVUs

Endoscopic total ethmoidectomy removes disease from both anterior and posterior ethmoid air cells during operative treatment of ethmoid sinus disease.

CMS RVU26DEffective Oct 1, 2026109 payment localities6.8K Medicare services in 2024

Medicare pays $273.22 for 31255 nationally in a facility.

Medicare rate · 31255

Ethmoidectomy

Work RVUs
5.61
Total RVUs
8.18
Global days
000

National rate · 2026

$273.22

Facility setting, before claim adjustments.

See every locality for 31255 →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 31255 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 31255 covers

An otolaryngologist uses a nasal endoscope to operate on the ethmoid sinuses, removing the anterior and posterior ethmoid air cells. This procedure may be performed for chronic ethmoid sinus disease, including disease associated with nasal polyps, in a hospital or ambulatory surgical setting. The operative report should identify the side treated and document the extent of ethmoid dissection.

Report this code when the surgeon performs a total ethmoidectomy, rather than a partial ethmoidectomy. If the operation also includes frontal sinus exploration or sphenoid sinus surgery, select the applicable combined endoscopy code when its service is performed. CMS applies endoscopy family pricing when related endoscopies are performed together. For bilateral surgery, modifier 50 is paid at 150%. The 0-day global period includes same-day preoperative and postoperative care. CMS 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 31255 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

31255 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$254.03
Alaska*Unavailable$358.41
ArizonaUnavailable$267.46
ArkansasUnavailable$251.69
AtlantaUnavailable$280.22
AustinUnavailable$273.86
BakersfieldUnavailable$271.68
Baltimore/Surr. CntysUnavailable$286.98
BeaumontUnavailable$266.01
BrazoriaUnavailable$268.17

31255 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
31255 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 31255 rate is calculated

Each of 31255’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 · 31255

RVUs × geographic indexes × conversion factor

Work5.61

5.61 RVUs× 1.000 GPCI

Practice expense1.75

1.75 RVUs× 1.000 GPCI

Malpractice0.82

0.82 RVUs× 1.000 GPCI

Adjusted RVUs

8.1800

Conversion factor

$33.4009

Medicare rate

$273.22

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 31255

The CMS indicators that decide how 31255 is paid alongside other services.

CMS payment indicators · 31255

Ethmoidectomy

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

31255 without 50 · national facility

$273.22

Ethmoidectomy

31255-50 · Bilateral: 150%

$409.83

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

31255 compared with similar codes

Compare codes · National

5 codes, side by side

  • 31255

    Ethmoidectomy5.61 wRVU

    Not priced

  • 31254

    Ethmoidectomy4.16 wRVU

    $436.55

  • 31253

    Sinus endoscopy8.78 wRVU

    Not priced

  • 31257

    Sinus endoscopy7.8 wRVU

    Not priced

  • 31259

    Sinus endoscopy8.27 wRVU

    Not priced

How to choose

31254Ethmoidectomy
Choose 31254 for partial ethmoidectomy. This code represents treatment of both anterior and posterior ethmoid cells.
31253Sinus endoscopy
Choose 31253 when total ethmoidectomy is performed with frontal sinus exploration; use 31255 for total ethmoidectomy without that combination.
31257Sinus endoscopy
Choose 31257 when total ethmoidectomy is combined with sphenoidotomy. This code covers the total ethmoidectomy alone.
31259Sinus endoscopy
Choose 31259 when total ethmoidectomy is combined with sphenoidotomy and sphenoid tissue removal. This code does not describe that combined sphenoid service.

Codes related to 31255

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

Codes related to 31255
CodeHow it relatesNational office range
Same family
31254EthmoidectomyPartial ethmoidectomy; distinguishes limited ethmoid dissection from the total procedure.$387.69–$565.22
Used instead
31253Sinus endoscopyCombines total ethmoidectomy with frontal sinus exploration.No office rate
31257Sinus endoscopyCombines total ethmoidectomy with sphenoidotomy.No office rate
31259Sinus endoscopyCombines total ethmoidectomy with sphenoidotomy and sphenoid tissue removal.No office rate

31255 billing questions

How do I distinguish this from 31254?

Use 31255 for a total ethmoidectomy involving anterior and posterior ethmoid cells. Code 31254 describes a partial ethmoidectomy.

What if frontal or sphenoid sinus surgery is also performed?

Check whether a combined code describes the total ethmoidectomy and the additional sinus work. Codes 31253, 31257, and 31259 cover specified combinations with frontal or sphenoid procedures.

What documentation supports reporting 31255?

The operative report should establish that the surgeon treated both anterior and posterior ethmoid cells and identify the side or sides operated on.

How is bilateral surgery handled under the CMS rules?

Report modifier 50 for a bilateral procedure; CMS pays the bilateral service at 150%.

Can an assistant or co-surgeon be reported?

CMS 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 31255PPRRVU2026_Oct_nonQPP.csv, line 3,536 (RVU26D)

Open CMS sourceHow we calculate rates

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