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Billing code 31611: Voice fistulaMedicare rate & RVUs

Creates a tracheoesophageal passage and places a voice prosthesis, typically for speech restoration after total laryngectomy.

CMS RVU26DEffective Oct 1, 2026109 payment localities551 Medicare services in 2024

Medicare pays $490.99 for 31611 nationally in a facility.

Medicare rate · 31611

Voice fistula

Swap in your local Medicare rate.

Work RVUs
5.85
Total RVUs
14.70
Global days
090

National rate · 2026

$490.99

Facility setting, before claim adjustments.

See every locality for 31611 → · 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 31611 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 31611 covers

An otolaryngologist or head and neck surgeon creates a controlled opening between the trachea and esophagus and inserts a voice prosthesis. The passage lets exhaled air reach the pharyngoesophageal segment to support speech after removal of the larynx. The procedure may be done during the laryngectomy as a primary puncture or later as a secondary puncture in a patient with an established laryngectomy stoma.

Report the service when the operative work includes construction of the fistula and placement of the prosthesis; documentation should identify the procedure, the prosthesis, and whether the puncture is primary or secondary. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this service. 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 31611 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

31611 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$445.06
Alaska*Unavailable$592.97
ArizonaUnavailable$478.55
ArkansasUnavailable$439.32
AtlantaUnavailable$501.68
AustinUnavailable$503.53
BakersfieldUnavailable$508.93
Baltimore/Surr. CntysUnavailable$520.46
BeaumontUnavailable$464.94
BrazoriaUnavailable$483.76

31611 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
31611 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 31611 rate is calculated

Each of 31611’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 · 31611

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.85Practice expense 7.98Malpractice 0.87

14.7000 adjusted RVUs×$33.4009 conversion factor=$490.99

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

Payment rules and modifiers for 31611

31611 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 31611

Voice fistula

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 · 31611

Voice fistula

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

31611 without 51 · national facility

$490.99

Voice fistula

31611-51 · Second procedure: 50%

$245.50

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

31611 compared with similar codes

Compare codes

31611 vs 31610 vs 31613 vs 31614 vs 31615: national Medicare rates

Swap in your local Medicare rate.

  • 31611
    Voice fistula · 5.85 wRVU
    —
  • 31610
    Tracheostomy · 11.7 wRVU
    —
  • 31613
    Stoma revision · 4.59 wRVU
    —
  • 31614
    Stoma revision · 8.41 wRVU
    —
  • 31615
    Airway endoscopy · 1.79 wRVU
    $173.02

How to choose

31610Tracheostomy
31610 creates a tracheostomy with a skin flap; 31611 creates a tracheoesophageal passage and inserts a voice prosthesis.
31613Stoma revision
31613 revises a tracheostoma using a simple approach. It does not describe construction of a tracheoesophageal voice passage with prosthesis placement.
31614Stoma revision
31614 is for complex tracheostoma revision, rather than creating a tracheoesophageal fistula and placing a voice prosthesis.
31615Airway endoscopy
31615 describes endoscopic examination through an established tracheostomy. It is an airway examination, not voice-fistula construction.

Codes related to 31611

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

Codes related to 31611
CodeHow it relatesNational office range
Often billed with
31360LaryngectomyMay accompany primary tracheoesophageal puncture performed during total laryngectomy.No office rate
31365LaryngectomyMay accompany primary tracheoesophageal puncture performed during total laryngectomy with radical neck dissection.No office rate

31611 billing questions

How is this different from a tracheostomy?

This procedure creates a passage between the trachea and esophagus and places a voice prosthesis for speech after laryngectomy. A tracheostomy creates an airway opening through the neck.

Can it be performed during a total laryngectomy?

Yes. A primary tracheoesophageal puncture may be created during total laryngectomy; a secondary puncture is performed later through the established laryngectomy stoma.

Should modifier 50 be used for a bilateral procedure?

No. The anatomy and service described do not support a bilateral adjustment or modifier 50.

What does the 90-day global period include?

It includes the day-before preoperative visit and 90 days of related postoperative care.

How does the multiple-procedure reduction affect this code?

When performed in the same session with other procedures, the highest-valued procedure is paid in full and the other procedures at 50%. The reduction depends on the relative values of the procedures in that session.

What documentation supports reporting the service?

The operative report should describe creation of the tracheoesophageal passage and insertion of the voice prosthesis, and indicate whether the puncture was primary or secondary.

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 31611PPRRVU2026_Oct_nonQPP.csv, line 3,626 (RVU26D)

Open CMS sourceHow we calculate rates

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