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Billing code 31259: Sinus endoscopyMedicare rate & RVUs

Reports endoscopic removal of anterior and posterior ethmoid tissue combined with sphenoid sinus opening and removal of sphenoid sinus tissue.

CMS RVU26DEffective Oct 1, 2026109 payment localities7.3K Medicare services in 2024

Medicare pays $397.14 for 31259 nationally in a facility.

Medicare rate · 31259

Sinus endoscopy

Work RVUs
8.27
Total RVUs
11.89
Global days
000

National rate · 2026

$397.14

Facility setting, before claim adjustments.

See every locality for 31259 →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 31259 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 31259 covers

An otolaryngologist, often a rhinologist, performs this endoscopic sinus operation to treat disease involving both the ethmoid and sphenoid sinuses. The surgeon removes tissue from the anterior and posterior ethmoid air cells, opens the sphenoid sinus, and removes tissue from within it. Typical cases involve chronic inflammatory disease or polyps affecting these areas, with surgery commonly performed in an operating room.

Select this code when the operative report supports the full ethmoid work and removal of tissue from the sphenoid sinus; an opening alone is not enough for the tissue-removal component. The 0-day global period includes same-day preoperative and postoperative care. When related endoscopies are performed together, CMS endoscopy family pricing applies. For bilateral surgery, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery, and does not permit co-surgeons or team surgery for this service.

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 31259 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

31259 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$369.43
Alaska*Unavailable$522.16
ArizonaUnavailable$388.78
ArkansasUnavailable$366.07
AtlantaUnavailable$407.44
AustinUnavailable$397.69
BakersfieldUnavailable$394.15
Baltimore/Surr. CntysUnavailable$417.07
BeaumontUnavailable$387.03
BrazoriaUnavailable$389.66

31259 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
31259 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 31259 rate is calculated

Each of 31259’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 · 31259

RVUs × geographic indexes × conversion factor

Work8.27

8.27 RVUs× 1.000 GPCI

Practice expense2.40

2.40 RVUs× 1.000 GPCI

Malpractice1.22

1.22 RVUs× 1.000 GPCI

Adjusted RVUs

11.8900

Conversion factor

$33.4009

Medicare rate

$397.14

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

Payment rules and modifiers for 31259

The CMS indicators that decide how 31259 is paid alongside other services.

CMS payment indicators · 31259

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

31259 without 50 · national facility

$397.14

Sinus endoscopy

31259-50 · Bilateral: 150%

$595.71

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

31259 compared with similar codes

Compare codes · National

4 codes, side by side

  • 31259

    Sinus endoscopy8.27 wRVU

    Not priced

  • 31257

    Sinus endoscopy7.8 wRVU

    Not priced

  • 31255

    Ethmoidectomy5.61 wRVU

    Not priced

  • 31288

    Sphenoid surgery4 wRVU

    Not priced

How to choose

31257Sinus endoscopy
Choose 31259 when tissue is removed from the sphenoid sinus. Choose 31257 when the sphenoid sinus is opened without that tissue removal, with total ethmoid work also performed.
31255Ethmoidectomy
31255 represents total ethmoid work without a sphenoid procedure. It does not capture sphenoidotomy or sphenoid tissue removal.
31288Sphenoid surgery
31288 covers sphenoidotomy with sphenoid tissue removal when total ethmoidectomy is not part of the service. Use 31259 when the total ethmoid work is also performed.

Codes related to 31259

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

Codes related to 31259
CodeHow it relatesNational office range
Same family
31257Sinus endoscopyCombines total ethmoid work and sphenoidotomy without sphenoid tissue removal.No office rate
31255EthmoidectomyTotal ethmoid work without the sphenoid procedure.No office rate
Used instead
31288Sphenoid surgerySphenoid tissue removal without the total ethmoid work included here.No office rate
31287SphenoidotomySphenoidotomy without tissue removal or total ethmoidectomy.No office rate

31259 billing questions

How does this differ from 31257?

Use 31259 when tissue is removed from the sphenoid sinus along with the total ethmoid work. Code 31257 describes the combination without sphenoid tissue removal.

Can I report 31257 separately for the same side?

Do not separately report 31257 for the ethmoidectomy and sphenoidotomy already represented by 31259 on that side. The operative report should support the added sphenoid tissue removal.

What documentation supports the tissue-removal portion?

The operative note should identify tissue removed from within the sphenoid sinus, in addition to the anterior and posterior ethmoid work. A sphenoid opening by itself does not establish that detail.

How is bilateral surgery reported under the CMS facts?

Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.

Can an assistant surgeon or co-surgeon be billed?

Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.

What happens when other sinus endoscopies are performed in the same session?

CMS endoscopy family pricing applies when related endoscopies are performed together. The operative documentation should distinguish the sinus sites and work performed.

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 31259PPRRVU2026_Oct_nonQPP.csv, line 3,539 (RVU26D)

Open CMS sourceHow we calculate rates

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