Billing code 31820: Tracheal closureMedicare rate & RVUs
Reports surgical closure of a persistent tracheostomy opening or fistula when the surgeon closes the tract without plastic reconstruction.
Medicare pays $445.90 for 31820 nationally in the office and $300.27 in a hospital or facility. Local office rates run $396.39–$571.99.
Medicare rate · 31820
Tracheal closure
Swap in your local Medicare rate.
- Work RVUs
- 4.52
- Total RVUs
- 13.35
- Global days
- 090
National rate · 2026
$445.90
Office setting, before claim adjustments.
See every locality for 31820 → · 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
What 31820 covers
This service closes a persistent opening between the trachea and skin, commonly a tracheocutaneous fistula that remains after a tracheostomy tube has been removed. An otolaryngologist or thoracic surgeon typically performs the operation in a surgical setting, closing the tract without plastic reconstruction. The code is for closure of the established opening, rather than repair of an acute tracheal injury or revision of a tracheostomy scar alone.
Select this code when the operative report supports closure without plastic repair. Documentation should identify the opening being treated and describe the closure performed. The 90-day global period includes 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% reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires documentation of medical necessity; 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 31820 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$396.39 to $571.99
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $401.91 | $274.49 |
| Alaska* | $528.71 | $373.62 |
| Arizona | $434.15 | $293.04 |
| Arkansas | $396.39 | $271.29 |
| Atlanta | $455.34 | $307.38 |
| Austin | $459.35 | $305.27 |
| Bakersfield | $465.86 | $306.25 |
| Baltimore/Surr. Cntys | $473.63 | $317.37 |
| Beaumont | $419.80 | $287.27 |
| Brazoria | $439.59 | $295.28 |
| Chicago | $478.16 | $331.81 |
| Chico | $463.88 | $304.27 |
| Colorado | $460.07 | $305.12 |
| Connecticut | $474.70 | $317.85 |
| Dallas | $442.90 | $297.86 |
| Dc + Md/Va Suburbs | $505.05 | $333.50 |
| Delaware | $441.07 | $297.19 |
| Detroit | $452.20 | $311.67 |
| East St. Louis | $447.52 | $313.54 |
| El Centro | $463.99 | $304.38 |
| Fort Lauderdale | $468.06 | $320.54 |
| Fort Worth | $440.48 | $296.89 |
| Fresno | $463.88 | $304.27 |
| Galveston | $441.24 | $296.63 |
| Hanford-Corcoran | $463.88 | $304.27 |
| Hawaii, Guam | $473.45 | $307.87 |
| Houston | $453.87 | $309.26 |
| Idaho | $412.01 | $278.03 |
| Indiana | $414.21 | $279.21 |
| Iowa | $408.89 | $275.65 |
| Kansas | $408.37 | $276.72 |
| Kentucky | $413.76 | $284.30 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $494.10 | $321.83 |
| Madera | $463.88 | $304.27 |
| Manhattan | $513.11 | $343.89 |
| Merced | $463.88 | $304.27 |
| Metropolitan Boston | $502.30 | $328.42 |
| Metropolitan Kansas City | $428.79 | $292.04 |
| Metropolitan Philadelphia | $464.21 | $312.62 |
| Metropolitan St. Louis | $432.90 | $294.26 |
| Miami | $492.29 | $340.69 |
| Minnesota | $437.56 | $287.71 |
| Mississippi | $402.10 | $276.71 |
| Modesto | $463.88 | $304.27 |
| Montana** | $445.86 | $300.23 |
| Napa | $530.53 | $338.60 |
| Nebraska | $410.63 | $276.22 |
| Nevada** | $442.33 | $296.55 |
| New Hampshire | $454.17 | $302.57 |
| New Mexico | $427.97 | $294.43 |
| New Orleans | $433.00 | $295.96 |
| North Carolina | $419.37 | $283.50 |
| North Dakota** | $432.21 | $286.58 |
| Northern Nj | $500.48 | $331.55 |
| Nyc Suburbs/Long Island | $526.70 | $353.55 |
| Ohio | $422.43 | $289.47 |
| Oklahoma | $411.67 | $281.63 |
| Oxnard-Thousand Oaks-Ventura | $490.92 | $318.79 |
| Portland | $472.60 | $310.80 |
| Poughkpsie/N Nyc Suburbs | $483.36 | $323.90 |
| Puerto Rico | $448.55 | $301.32 |
| Queens | $515.23 | $343.10 |
| Redding | $463.88 | $304.27 |
| Rest Of California | $463.88 | $304.27 |
| Rest Of Florida | $445.53 | $306.31 |
| Rest Of Georgia | $420.96 | $291.06 |
| Rest Of Illinois | $435.22 | $302.27 |
| Rest Of Louisiana | $413.67 | $284.79 |
| Rest Of Maine | $415.44 | $281.46 |
| Rest Of Maryland | $448.78 | $301.41 |
| Rest Of Massachusetts | $458.05 | $304.70 |
| Rest Of Michigan | $425.22 | $292.26 |
| Rest Of Missouri | $407.78 | $282.25 |
| Rest Of New Jersey | $479.19 | $320.16 |
| Rest Of New York | $425.46 | $287.12 |
| Rest Of Oregon | $437.97 | $292.92 |
| Rest Of Pennsylvania | $422.34 | $288.65 |
| Rest Of Texas | $429.80 | $291.60 |
| Rest Of Washington | $456.77 | $303.42 |
| Rhode Island | $455.25 | $304.82 |
| Riverside-San Bernardino-Ontario | $471.33 | $311.72 |
| Sacramento-Roseville-Folsom | $484.96 | $315.60 |
| Salinas | $483.12 | $314.34 |
| San Diego-Chula Vista-Carlsbad | $493.16 | $318.99 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $559.25 | $353.91 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $558.46 | $353.13 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $571.99 | $361.99 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $568.78 | $358.79 |
| San Luis Obispo-Paso Robles | $475.57 | $309.70 |
| Santa Cruz-Watsonville | $496.83 | $319.90 |
| Santa Maria-Santa Barbara | $484.57 | $314.77 |
| Santa Rosa-Petaluma | $501.73 | $322.90 |
| Seattle (King Cnty) | $510.95 | $332.27 |
| South Carolina | $421.78 | $287.22 |
| South Dakota** | $430.60 | $284.97 |
| Southern Maine | $434.95 | $290.63 |
| Stockton | $463.88 | $304.27 |
| Suburban Chicago | $472.09 | $322.53 |
| Tennessee | $410.49 | $278.11 |
| Utah | $427.24 | $290.35 |
| Vallejo | $529.40 | $337.47 |
| Vermont | $431.80 | $287.63 |
| Virgin Islands | $448.55 | $301.32 |
| Virginia | $434.50 | $291.35 |
| Visalia | $463.88 | $304.27 |
| West Virginia | $420.22 | $293.67 |
| Wisconsin | $418.53 | $279.02 |
| Wyoming** | $439.91 | $294.28 |
| Yuba City | $463.88 | $304.27 |
31820 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$396.39
$528.71
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $528.71 | 1 |
| AL | $401.91 | 1 |
| AR | $396.39 | 1 |
| AZ | $434.15 | 1 |
| CA | $463.88–$571.99 | 29 |
| CO | $460.07 | 1 |
| CT | $474.70 | 1 |
| DC | $505.05 | 1 |
| DE | $441.07 | 1 |
| FL | $445.53–$492.29 | 3 |
| GA | $420.96–$455.34 | 2 |
| GU | $473.45 | 1 |
| HI | $473.45 | 1 |
| IA | $408.89 | 1 |
| ID | $412.01 | 1 |
| IL | $435.22–$478.16 | 4 |
| IN | $414.21 | 1 |
| KS | $408.37 | 1 |
| KY | $413.76 | 1 |
| LA | $413.67–$433.00 | 2 |
| MA | $458.05–$502.30 | 2 |
| MD | $448.78–$505.05 | 3 |
| ME | $415.44–$434.95 | 2 |
| MI | $425.22–$452.20 | 2 |
| MN | $437.56 | 1 |
| MO | $407.78–$432.90 | 3 |
| MS | $402.10 | 1 |
| MT | $445.86 | 1 |
| NC | $419.37 | 1 |
| ND | $432.21 | 1 |
| NE | $410.63 | 1 |
| NH | $454.17 | 1 |
| NJ | $479.19–$500.48 | 2 |
| NM | $427.97 | 1 |
| NV | $442.33 | 1 |
| NY | $425.46–$526.70 | 5 |
| OH | $422.43 | 1 |
| OK | $411.67 | 1 |
| OR | $437.97–$472.60 | 2 |
| PA | $422.34–$464.21 | 2 |
| PR | $448.55 | 1 |
| RI | $455.25 | 1 |
| SC | $421.78 | 1 |
| SD | $430.60 | 1 |
| TN | $410.49 | 1 |
| TX | $419.80–$459.35 | 8 |
| UT | $427.24 | 1 |
| VA | $434.50–$505.05 | 2 |
| VI | $448.55 | 1 |
| VT | $431.80 | 1 |
| WA | $456.77–$510.95 | 2 |
| WI | $418.53 | 1 |
| WV | $420.22 | 1 |
| WY | $439.91 | 1 |
How the 31820 rate is calculated
Each of 31820’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 · 31820
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 4.52Practice expense 8.14Malpractice 0.69
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 31820
31820 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 31820
Tracheal closure
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.76/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 31820
Tracheal closure
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
31820 without 51 · national office
$445.90
Tracheal closure
31820-51 · Second procedure: 50%
$222.95
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%).
31820 compared with similar codes
Compare codes
31820 vs 31825 vs 31800 vs 31805 vs 31830: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 31825Tracheal defect repair
- Choose 31820 for closure without plastic repair; 31825 describes closure that includes plastic repair.
- 31800Tracheal repair
- 31800 is for cervical tracheal injury repair. 31820 is for closing a tracheostomy opening or fistula.
- 31805Tracheal repair
- 31805 is for repair of a thoracic tracheal injury; 31820 closes a tracheostomy opening or fistula.
- 31830Tracheal scar revision
- 31830 addresses revision of a tracheostomy scar. Use 31820 when the service closes a persistent opening or fistula.
31820 billing questions
How does this differ from 31825?
31820 is for closure without plastic repair. Use 31825 when the closure includes plastic repair.
Is this the code for an acute tracheal injury?
No. This code describes closure of a tracheostomy opening or fistula. Codes 31800 and 31805 describe tracheal repair for injury, depending on the site.
Can modifier 50 be used for openings on both sides?
No. The code's descriptor and anatomy make bilateral adjustment inappropriate; do not append modifier 50.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
When may an assistant-at-surgery be paid?
Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons and team surgery are not permitted for this code.
How does another procedure in the same session affect payment?
The highest-valued procedure is paid in full, and other procedures performed in that session are subject to the standard multiple procedure reduction.
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
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