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Billing code 31256: Maxillary antrostomyMedicare rate & RVUs

Report this procedure for endoscopic creation or enlargement of a maxillary sinus opening for drainage, without removing tissue from the sinus.

CMS RVU26DEffective Oct 1, 2026109 payment localities11.5K Medicare services in 2024

Medicare pays $152.64 for 31256 nationally in a facility.

Medicare rate · 31256

Maxillary antrostomy

Swap in your local Medicare rate.

Work RVUs
3.03
Total RVUs
4.57
Global days
000

National rate · 2026

$152.64

Facility setting, before claim adjustments.

See every locality for 31256 → · 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 31256 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 31256 covers

An otolaryngologist typically performs this endoscopic procedure through the nasal passage to create or enlarge an opening into a maxillary sinus, improving access and drainage. It is used in surgical treatment of conditions such as chronic maxillary sinusitis when an operative antrostomy is performed. The code describes the sinus opening, not removal of tissue from within the maxillary sinus.

Select this code when the operative report supports a surgical maxillary antrostomy without maxillary sinus tissue removal; use the tissue-removal sibling when tissue is removed from the sinus. Document the side, the work performed, and whether sinus tissue was removed. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral work, modifier 50 is paid at 150%. 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.

Where 31256 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

31256 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$141.77
Alaska*Unavailable$199.21
ArizonaUnavailable$149.42
ArkansasUnavailable$140.45
AtlantaUnavailable$156.43
AustinUnavailable$153.36
BakersfieldUnavailable$152.51
Baltimore/Surr. CntysUnavailable$160.37
BeaumontUnavailable$148.29
BrazoriaUnavailable$149.96

31256 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
31256 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 31256 rate is calculated

Each of 31256’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 · 31256

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 3.03Practice expense 1.11Malpractice 0.43

4.5700 adjusted RVUs×$33.4009 conversion factor=$152.64

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

Payment rules and modifiers for 31256

The CMS indicators that decide how 31256 is paid alongside other services.

CMS payment indicators · 31256

Maxillary antrostomy

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

31256 without 50 · national facility

$152.64

Maxillary antrostomy

31256-50 · Bilateral: 150%

$228.96

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

31256 compared with similar codes

Compare codes

31256 vs 31267 vs 31233 vs 31231 vs 31254: national Medicare rates

Swap in your local Medicare rate.

  • 31256
    Maxillary antrostomy · 3.03 wRVU
    —
  • 31267
    Sinus endoscopy · 4.56 wRVU
    —
  • 31233
    Sinus endoscopy · 2.13 wRVU
    $272.55
  • 31231
    Nasal endoscopy · 1.07 wRVU
    $193.39
  • 31254
    Ethmoidectomy · 4.16 wRVU
    $436.55

How to choose

31267Sinus endoscopy
Choose 31256 when the maxillary antrostomy is performed without removing tissue from within the sinus. Choose 31267 when sinus tissue is removed.
31233Sinus endoscopy
31233 is diagnostic maxillary sinus endoscopy. This code describes an operative antrostomy, not inspection alone.
31231Nasal endoscopy
31231 describes diagnostic nasal endoscopy. It does not represent surgical opening of the maxillary sinus.
31254Ethmoidectomy
31254 describes partial ethmoidectomy, an operation on the ethmoid sinus. This code describes a maxillary sinus antrostomy.

Codes related to 31256

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

Codes related to 31256
CodeHow it relatesNational office range
Same family
31267Sinus endoscopyMaxillary antrostomy with tissue removal from the sinus.No office rate
Used instead
31233Sinus endoscopyDiagnostic maxillary sinus endoscopy without a surgical antrostomy.$240.71–$360.32
31231Nasal endoscopyDiagnostic nasal endoscopy without the operative maxillary sinus opening.$169.32–$262.16
Often billed with
31254EthmoidectomyPartial ethmoidectomy may be performed during the same endoscopic sinus operation.$387.69–$565.22
31255EthmoidectomyTotal ethmoidectomy may be performed during the same endoscopic sinus operation.No office rate

31256 billing questions

How does this differ from 31267?

This code describes a maxillary antrostomy without removal of tissue from the maxillary sinus. Report 31267 when tissue is removed from within the sinus.

Can diagnostic nasal endoscopy be reported instead?

No, when the service includes a surgical maxillary antrostomy. Diagnostic endoscopy codes describe examination without this operative opening.

What should the operative report document?

Document the side, the maxillary sinus opening performed, and whether tissue was removed from within the sinus. These details support selection between this code and 31267.

How is bilateral work reported?

Use modifier 50 for bilateral performance; CMS pays the bilateral procedure at 150%.

Can an assistant, co-surgeon, or surgical team be paid?

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 31256PPRRVU2026_Oct_nonQPP.csv, line 3,537 (RVU26D)

Open CMS sourceHow we calculate rates

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