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Billing code 31613: Stoma revisionMedicare rate & RVUs

Revision of a narrowed or poorly shaped tracheostomy opening to improve its form or function, when the operative work is simple rather than complex.

CMS RVU26DEffective Oct 1, 2026109 payment localities421 Medicare services in 2024

Medicare pays $396.13 for 31613 nationally in a facility.

Medicare rate · 31613

Stoma revision

Swap in your local Medicare rate.

Work RVUs
4.59
Total RVUs
11.86
Global days
090

National rate · 2026

$396.13

Facility setting, before claim adjustments.

See every locality for 31613 → · 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 31613 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 31613 covers

An otolaryngologist or other surgeon revises an established tracheostoma when scar, narrowing, or deformity interferes with the opening’s function or the fit of a tracheostomy tube. The work reshapes the stoma, often using nearby tissue, rather than creating a new tracheostomy. It is performed in a surgical setting and is distinct from endoscopic inspection of the airway through an existing stoma.

Choose this code when the operative report supports a simple revision; use the complex revision code when the reconstruction is more extensive. Document the stoma’s problem, the revision performed, and the extent of tissue work. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and the others at 50%. Assistant-at-surgery services are not paid under the statutory restriction; 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 31613 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

31613 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$358.04
Alaska*Unavailable$475.70
ArizonaUnavailable$385.78
ArkansasUnavailable$353.28
AtlantaUnavailable$405.11
AustinUnavailable$406.22
BakersfieldUnavailable$410.16
Baltimore/Surr. CntysUnavailable$420.42
BeaumontUnavailable$374.76
BrazoriaUnavailable$389.89

31613 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
31613 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 31613 rate is calculated

Each of 31613’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 · 31613

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 4.59Practice expense 6.52Malpractice 0.75

11.8600 adjusted RVUs×$33.4009 conversion factor=$396.13

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

Payment rules and modifiers for 31613

31613 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 31613

Stoma revision

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)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
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 · 31613

Stoma revision

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

31613 without 51 · national facility

$396.13

Stoma revision

31613-51 · Second procedure: 50%

$198.07

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

31613 compared with similar codes

Compare codes

31613 vs 31614 vs 31600 vs 31615: national Medicare rates

Swap in your local Medicare rate.

  • 31613
    Stoma revision · 4.59 wRVU
    —
  • 31614
    Stoma revision · 8.41 wRVU
    —
  • 31600
    Tracheostomy · 5.42 wRVU
    —
  • 31615
    Airway endoscopy · 1.79 wRVU
    $173.02

How to choose

31614Stoma revision
Both codes revise an established tracheostoma. Select 31613 for simple revision and 31614 when the documented reconstruction is complex.
31600Tracheostomy
31600 creates a planned tracheostomy; 31613 revises an existing tracheostoma.
31615Airway endoscopy
31615 describes endoscopic examination through an established tracheostomy, not surgical reshaping of the stoma.

Codes related to 31613

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

Codes related to 31613
CodeHow it relatesNational office range
Same family
31614Stoma revisionComplex revision of an established tracheostoma.No office rate
Used instead
31600TracheostomyCreates a planned tracheostomy rather than revising an existing stoma.No office rate
Often billed with
31615Airway endoscopyAirway endoscopy through an established tracheostomy, when separately performed and documented.$154.18–$222.08

31613 billing questions

How do I choose between this code and 31614?

Use 31613 for a simple revision of an existing tracheostoma. Use 31614 when the operative report documents a complex reconstruction.

Is this code for creating a new tracheostomy?

No. It describes revision of an established stoma; planned creation of a tracheostomy is reported with a creation code such as 31600.

What documentation supports the simple revision?

Document the existing stoma’s narrowing, scar, or deformity, its functional effect, and the specific revision and tissue work performed. The operative detail should support the simple rather than complex level.

Can modifier 50 be reported?

No. The descriptor and anatomy do not support bilateral reporting with modifier 50.

What postoperative care is included?

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?

Medicare does not pay an assistant at surgery for this code under the statutory restriction. 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 31613PPRRVU2026_Oct_nonQPP.csv, line 3,628 (RVU26D)

Open CMS sourceHow we calculate rates

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