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Billing code 31591: LaryngoplastyMedicare rate & RVUs

Reports framework surgery that moves one vocal fold toward the midline, commonly to improve glottic closure in unilateral vocal fold paralysis.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.1K Medicare services in 2024

Medicare pays $999.69 for 31591 nationally in a facility.

Medicare rate · 31591

Laryngoplasty

Work RVUs
13.22
Total RVUs
29.93
Global days
090

National rate · 2026

$999.69

Facility setting, before claim adjustments.

See every locality for 31591 →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 31591 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 31591 covers

An otolaryngologist or laryngologist performs this framework procedure to move one vocal fold toward the midline and improve glottic closure. A typical indication is unilateral vocal fold paralysis or immobility causing a persistent voice or airway-protection problem. In a type I thyroplasty approach, the surgeon works through the neck and adjusts the thyroid cartilage framework, commonly placing an implant to medialize the fold. The procedure is generally performed in an operating room.

Report the code for unilateral medialization surgery, not for endoscopic injection augmentation or diagnostic examination alone. The operative report should identify the treated side, the indication, and the framework work performed. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. For multiple procedures in one session, the highest-valued procedure is paid in full and the others at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery and co-surgeon payment require the documentation described in CMS rules; 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 31591 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

31591 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$910.00
Alaska*Unavailable$1,223.61
ArizonaUnavailable$975.10
ArkansasUnavailable$898.82
AtlantaUnavailable$1,021.87
AustinUnavailable$1,021.86
BakersfieldUnavailable$1,030.27
Baltimore/Surr. CntysUnavailable$1,058.07
BeaumontUnavailable$950.68
BrazoriaUnavailable$984.60

31591 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
31591 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 31591 rate is calculated

Each of 31591’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 · 31591

RVUs × geographic indexes × conversion factor

Work13.22

13.22 RVUs× 1.000 GPCI

Practice expense14.78

14.78 RVUs× 1.000 GPCI

Malpractice1.93

1.93 RVUs× 1.000 GPCI

Adjusted RVUs

29.9300

Conversion factor

$33.4009

Medicare rate

$999.69

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

Payment rules and modifiers for 31591

31591 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 31591

Laryngoplasty

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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
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 · 31591

Laryngoplasty

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned 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 50 · payment effect

With and without the modifier

31591 without 50 · national facility

$999.69

Laryngoplasty

31591-50 · Bilateral: 150%

$1,499.54

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

31591 compared with similar codes

Compare codes · National

4 codes, side by side

  • 31591

    Laryngoplasty13.22 wRVU

    Not priced

  • 31574

    Vocal fold injection2.37 wRVU

    $901.82

  • 31590

    Laryngeal reinnervation7.65 wRVU

    Not priced

  • 31575

    Laryngoscopy0.92 wRVU

    $127.26

How to choose

31574Vocal fold injection
Choose 31591 for framework medialization through the neck; choose 31574 for endoscopic injection augmentation.
31590Laryngeal reinnervation
31590 reports laryngeal reinnervation, which seeks to restore nerve input; 31591 mechanically medializes the vocal fold.
31575Laryngoscopy
31575 is diagnostic laryngoscopy. It does not represent the surgical framework work that supports 31591.

Codes related to 31591

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

Codes related to 31591
CodeHow it relatesNational office range
Used instead
31574Vocal fold injectionEndoscopic vocal fold injection augmentation is a different method for improving glottic closure.$781.69–$1,263.26
31590Laryngeal reinnervationLaryngeal reinnervation is another surgical approach for selected cases of vocal fold paralysis.No office rate
Often billed with
31599Unlisted procedure larynxMay represent separately performed arytenoid adduction when the operative report supports distinct work.No office rate

31591 billing questions

How does this differ from vocal fold injection augmentation?

This code describes framework surgery that medializes one vocal fold. Code 31574 is for endoscopic injection augmentation, a different method of addressing glottic insufficiency.

What documentation supports reporting this code?

Document the indication, the side treated, and the operative steps showing framework medialization. The record should distinguish the surgery from injection augmentation or a diagnostic laryngeal examination.

Can the procedure be reported bilaterally?

CMS lists bilateral payment with modifier 50 at 150%. The operative documentation should support treatment of both sides.

What postoperative care is included?

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

When is an assistant or co-surgeon paid?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeon payment requires supporting documentation, and team surgery is not permitted.

How are other procedures in the same session paid?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.

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 31591PPRRVU2026_Oct_nonQPP.csv, line 3,617 (RVU26D)

Open CMS sourceHow we calculate rates

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