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Billing code 31590: Laryngeal reinnervationMedicare rate & RVUs

Open laryngeal nerve reinnervation connects a donor ansa cervicalis motor branch to the recurrent laryngeal nerve to treat selected vocal fold paralysis.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $882.12 for 31590 nationally in a facility.

Medicare rate · 31590

Laryngeal reinnervation

Swap in your local Medicare rate.

Work RVUs
7.65
Total RVUs
26.41
Global days
090

National rate · 2026

$882.12

Facility setting, before claim adjustments.

See every locality for 31590 → · 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 31590 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 31590 covers

An otolaryngologist or head and neck surgeon performs this open neck procedure to restore neural input to a paralyzed vocal fold. The usual technique connects a motor branch of the ansa cervicalis to the distal recurrent laryngeal nerve. It is used for selected cases of vocal fold paralysis, including paralysis after thyroid or other neck surgery, when the clinical plan is to reinnervate the larynx rather than simply medialize the fold.

Report the code for the reinnervation procedure itself, not for laryngoscopic injection or framework medialization performed as a different treatment. The operative report should identify the donor and recipient nerves, the nerve connection performed, and the indication. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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 31590 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

31590 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$792.23
Alaska*Unavailable$1,031.38
ArizonaUnavailable$858.47
ArkansasUnavailable$780.90
AtlantaUnavailable$899.83
AustinUnavailable$912.54
BakersfieldUnavailable$928.91
Baltimore/Surr. CntysUnavailable$938.08
BeaumontUnavailable$826.43
BrazoriaUnavailable$870.63

31590 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
31590 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 31590 rate is calculated

Each of 31590’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 · 31590

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 7.65Practice expense 17.64Malpractice 1.12

26.4100 adjusted RVUs×$33.4009 conversion factor=$882.12

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

Payment rules and modifiers for 31590

31590 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 31590

Laryngeal reinnervation

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.76/0.14Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 31590

Laryngeal reinnervation

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

31590 without 51 · national facility

$882.12

Laryngeal reinnervation

31590-51 · Second procedure: 50%

$441.06

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

31590 compared with similar codes

Compare codes

31590 vs 31591 vs 31574 vs 31570: national Medicare rates

Swap in your local Medicare rate.

  • 31590
    Laryngeal reinnervation · 7.65 wRVU
    —
  • 31591
    Laryngoplasty · 13.22 wRVU
    —
  • 31574
    Vocal fold injection · 2.37 wRVU
    $901.82
  • 31570
    Vocal fold injection · 3.76 wRVU
    $344.36

How to choose

31591Laryngoplasty
Choose 31590 when the operation connects a donor nerve to the recurrent laryngeal nerve. Choose 31591 for laryngeal framework medialization.
31574Vocal fold injection
31574 reports laryngoscopic vocal fold injection for augmentation; 31590 reports open nerve reinnervation.
31570Vocal fold injection
31570 describes direct laryngoscopic therapeutic injection into the vocal fold, not an open nerve connection.

Codes related to 31590

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

Codes related to 31590
CodeHow it relatesNational office range
Used instead
31591LaryngoplastyFramework medialization treats vocal fold paralysis without reinnervating the larynx.No office rate
31574Vocal fold injectionLaryngoscopic vocal fold injection offers a different approach to improving glottic closure.$781.69–$1,263.26
31570Vocal fold injectionDirect laryngoscopic vocal fold injection is a different treatment from open nerve reinnervation.$306.62–$436.72

31590 billing questions

How is 31590 different from medialization laryngoplasty 31591?

31590 reinnervates the larynx by connecting a donor motor nerve to the recurrent laryngeal nerve. Code 31591 describes framework surgery to medialize the vocal fold rather than nerve transfer.

When might 31574 be reported instead?

31574 is for laryngoscopic vocal fold injection to improve glottic closure. It is a different treatment approach from open nerve reinnervation and should be selected when injection, not nerve connection, is performed.

Should modifier 50 be appended for bilateral work?

No. CMS identifies modifier 50 as inappropriate for 31590 because the descriptor or anatomy does not support a bilateral adjustment.

What postoperative care is included in the global period?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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 31590PPRRVU2026_Oct_nonQPP.csv, line 3,616 (RVU26D)

Open CMS sourceHow we calculate rates

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