$1,688.11
31296 is the frontal sinus balloon-dilation service. Choose 31295 when the treated ostium is maxillary.
On this page
CMS RVU26D · Effective 2026-10-01
31295 in Austin
Office / nonfacility
$1661.86
Base rate per service
Facility setting
$135.61
Base rate per service
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
Nasal/sinus surgery
About 31295: Endoscopic maxillary sinus balloon dilation
Endoscopic balloon dilation of a maxillary sinus ostium is reported when an ENT surgeon enlarges its natural drainage opening without conventional tissue removal.
An otolaryngologist uses a nasal endoscope to guide a balloon into the natural opening of a maxillary sinus and enlarge that drainage pathway. This approach may be used for obstructed maxillary sinus drainage, including in patients with chronic or recurrent sinusitis. The procedure is distinct from creating a wider opening by removing tissue or bone during conventional endoscopic sinus surgery.
Report the code for the maxillary sinus ostium dilation performed, and document the treated side, the sinus, the technique, and the clinical findings supporting the intervention. CMS treats the service as a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When related endoscopies are performed together, endoscopy family pricing applies. CMS allows payment for an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 31295
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Endoscopy family pricing applies when related endoscopies are performed together.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.63 · 6%
- Practice expense (office) RVU44.21 · 94%
- Malpractice RVU0.39 · 1%
14.5K
Medicare services in 2024 · #1272 by national volume
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.
31295 compared with similar codes
Office rates for Austin, from the same CMS release.
$1,648.72
31297 applies to balloon dilation of the sphenoid sinus ostium, not the maxillary ostium.
No office rate
31256 represents conventional endoscopic maxillary sinus exploration and opening. Use 31295 when the documented intervention is balloon dilation of the ostium.
No office rate
31267 includes removal of tissue from the maxillary sinus. The defining intervention for 31295 is balloon dilation of the ostium.
The same code, a different location
How does Austin compare?
In Beaumont, the office rate for 31295 is $1443.70—$218.16 lower than the $1661.86 rate in Austin. Both use the same code, release and participation basis.
31295 across payment areas
Same release and payment basis · bars start at $0
Austin · This locality
$1661.86
$1443.70
$218.16 lower than Austin
$1562.07
$99.79 lower than Austin
$1570.56
$91.30 lower than Austin
$1555.96
$105.90 lower than Austin
$1565.65
$96.21 lower than Austin
$1572.79
$89.07 lower than Austin
Other payment areas listed in Texas appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
Across 109 of 109 CMS payment localities with a supported office rate, 31295 ranges from $1363.00 in Arkansas to $2233.82 in San Jose-Sunnyvale-Santa Clara (San Benito Cnty). This is a geographic range, not an average.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Rest Of Texas
Texas · 31295
Office
$1500.95
Facility
$131.94
$160.91 lower than Austin for the office setting.
Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty)
California · 31295
Office
$1846.98
Facility
$140.40
$185.12 higher than Austin for the office setting.
Dc + Md/Va Suburbs
District of Columbia · 31295
Office
$1846.58
Facility
$147.22
$184.72 higher than Austin for the office setting.
Miami
Florida · 31295
Office
$1657.98
Facility
$156.25
$3.88 lower than Austin for the office setting.
Chicago
Illinois · 31295
Office
$1602.39
Facility
$152.59
$59.47 lower than Austin for the office setting.
Manhattan
New York · 31295
Office
$1830.00
Facility
$153.71
$168.14 higher than Austin for the office setting.
Alaska*
Alaska · 31295
Office
$1711.58
Facility
$175.23
$49.72 higher than Austin for the office setting.
Alabama
Alabama · 31295
Office
$1387.29
Facility
$125.03
$274.57 lower than Austin for the office setting.
Arkansas
Arkansas · 31295
Office
$1363.00
Facility
$123.82
$298.86 lower than Austin for the office setting.
Arizona
Arizona · 31295
Office
$1529.87
Facility
$132.01
$131.99 lower than Austin for the office setting.
Bakersfield
California · 31295
Office
$1715.86
Facility
$134.79
$54.00 higher than Austin for the office setting.
Chico
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
El Centro
California · 31295
Office
$1714.80
Facility
$133.72
$52.94 higher than Austin for the office setting.
Fresno
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Hanford-Corcoran
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Madera
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Merced
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Modesto
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Napa
California · 31295
Office
$2046.23
Facility
$144.90
$384.37 higher than Austin for the office setting.
Oxnard-Thousand Oaks-Ventura
California · 31295
Office
$1843.82
Facility
$138.69
$181.96 higher than Austin for the office setting.
Redding
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Rest Of California
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Riverside-San Bernardino-Ontario
California · 31295
Office
$1718.95
Facility
$137.88
$57.09 higher than Austin for the office setting.
Sacramento-Roseville-Folsom
California · 31295
Office
$1815.34
Facility
$137.61
$153.48 higher than Austin for the office setting.
Salinas
California · 31295
Office
$1808.99
Facility
$137.04
$147.13 higher than Austin for the office setting.
San Diego-Chula Vista-Carlsbad
California · 31295
Office
$1863.62
Facility
$138.29
$201.76 higher than Austin for the office setting.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 31295
Office
$2184.25
Facility
$150.21
$522.39 higher than Austin for the office setting.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 31295
Office
$2183.81
Facility
$149.76
$521.95 higher than Austin for the office setting.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 31295
Office
$2233.82
Facility
$153.62
$571.96 higher than Austin for the office setting.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 31295
Office
$2232.01
Facility
$151.81
$570.15 higher than Austin for the office setting.
San Luis Obispo-Paso Robles
California · 31295
Office
$1778.23
Facility
$135.12
$116.37 higher than Austin for the office setting.
Santa Cruz-Watsonville
California · 31295
Office
$1890.81
Facility
$138.06
$228.95 higher than Austin for the office setting.
Santa Maria-Santa Barbara
California · 31295
Office
$1819.06
Facility
$137.01
$157.20 higher than Austin for the office setting.
Santa Rosa-Petaluma
California · 31295
Office
$1910.79
Facility
$139.30
$248.93 higher than Austin for the office setting.
Stockton
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Vallejo
California · 31295
Office
$2045.59
Facility
$144.26
$383.73 higher than Austin for the office setting.
Visalia
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Yuba City
California · 31295
Office
$1714.73
Facility
$133.66
$52.87 higher than Austin for the office setting.
Colorado
Colorado · 31295
Office
$1670.23
Facility
$135.32
$8.37 higher than Austin for the office setting.
Connecticut
Connecticut · 31295
Office
$1695.72
Facility
$142.06
$33.86 higher than Austin for the office setting.
Delaware
Delaware · 31295
Office
$1558.93
Facility
$133.65
$102.93 lower than Austin for the office setting.
Fort Lauderdale
Florida · 31295
Office
$1607.25
Facility
$145.91
$54.61 lower than Austin for the office setting.
Rest Of Florida
Florida · 31295
Office
$1519.10
Facility
$139.99
$142.76 lower than Austin for the office setting.
Atlanta
Georgia · 31295
Office
$1604.03
Facility
$138.37
$57.83 lower than Austin for the office setting.
Rest Of Georgia
Georgia · 31295
Office
$1420.55
Facility
$133.76
$241.31 lower than Austin for the office setting.
Hawaii, Guam
Hawaii · 31295
Office
$1774.34
Facility
$134.12
$112.48 higher than Austin for the office setting.
Iowa
Iowa · 31295
Office
$1444.15
Facility
$124.19
$217.71 lower than Austin for the office setting.
Idaho
Idaho · 31295
Office
$1452.53
Facility
$125.35
$209.33 lower than Austin for the office setting.
East St. Louis
Illinois · 31295
Office
$1472.60
Facility
$145.42
$189.26 lower than Austin for the office setting.
Rest Of Illinois
Illinois · 31295
Office
$1456.39
Facility
$139.31
$205.47 lower than Austin for the office setting.
Suburban Chicago
Illinois · 31295
Office
$1628.07
Facility
$146.53
$33.79 lower than Austin for the office setting.
Indiana
Indiana · 31295
Office
$1463.03
Facility
$125.76
$198.83 lower than Austin for the office setting.
Kansas
Kansas · 31295
Office
$1429.30
Facility
$125.21
$232.56 lower than Austin for the office setting.
Kentucky
Kentucky · 31295
Office
$1412.51
Facility
$130.05
$249.35 lower than Austin for the office setting.
New Orleans
Louisiana · 31295
Office
$1492.17
Facility
$134.70
$169.69 lower than Austin for the office setting.
Rest Of Louisiana
Louisiana · 31295
Office
$1407.16
Facility
$130.47
$254.70 lower than Austin for the office setting.
Metropolitan Boston
Massachusetts · 31295
Office
$1866.16
Facility
$143.72
$204.30 higher than Austin for the office setting.
Rest Of Massachusetts
Massachusetts · 31295
Office
$1654.55
Facility
$135.51
$7.31 lower than Austin for the office setting.
Baltimore/Surr. Cntys
Maryland · 31295
Office
$1689.81
Facility
$141.92
$27.95 higher than Austin for the office setting.
Rest Of Maryland
Maryland · 31295
Office
$1595.05
Facility
$135.16
$66.81 lower than Austin for the office setting.
Rest Of Maine
Maine · 31295
Office
$1454.47
Facility
$127.29
$207.39 lower than Austin for the office setting.
Southern Maine
Maine · 31295
Office
$1559.43
Facility
$129.83
$102.43 lower than Austin for the office setting.
Detroit
Michigan · 31295
Office
$1534.78
Facility
$142.68
$127.08 lower than Austin for the office setting.
Rest Of Michigan
Michigan · 31295
Office
$1450.74
Facility
$133.66
$211.12 lower than Austin for the office setting.
Minnesota
Minnesota · 31295
Office
$1611.18
Facility
$126.76
$50.68 lower than Austin for the office setting.
Metropolitan Kansas City
Missouri · 31295
Office
$1487.15
Facility
$132.56
$174.71 lower than Austin for the office setting.
Metropolitan St. Louis
Missouri · 31295
Office
$1506.67
Facility
$133.33
$155.19 lower than Austin for the office setting.
Rest Of Missouri
Missouri · 31295
Office
$1373.41
Facility
$129.90
$288.45 lower than Austin for the office setting.
Mississippi
Mississippi · 31295
Office
$1368.87
Facility
$126.80
$292.99 lower than Austin for the office setting.
Montana**
Montana · 31295
Office
$1577.50
Facility
$134.91
$84.36 lower than Austin for the office setting.
North Carolina
North Carolina · 31295
Office
$1473.89
Facility
$127.95
$187.97 lower than Austin for the office setting.
North Dakota**
North Dakota · 31295
Office
$1569.79
Facility
$127.20
$92.07 lower than Austin for the office setting.
Nebraska
Nebraska · 31295
Office
$1455.72
Facility
$124.21
$206.14 lower than Austin for the office setting.
New Hampshire
New Hampshire · 31295
Office
$1636.44
Facility
$134.71
$25.42 lower than Austin for the office setting.
Northern Nj
New Jersey · 31295
Office
$1820.21
Facility
$146.81
$158.35 higher than Austin for the office setting.
Rest Of New Jersey
New Jersey · 31295
Office
$1718.15
Facility
$142.85
$56.29 higher than Austin for the office setting.
New Mexico
New Mexico · 31295
Office
$1457.58
Facility
$134.73
$204.28 lower than Austin for the office setting.
Nevada**
Nevada · 31295
Office
$1576.83
Facility
$132.80
$85.03 lower than Austin for the office setting.
Nyc Suburbs/Long Island
New York · 31295
Office
$1873.40
Facility
$158.16
$211.54 higher than Austin for the office setting.
Poughkpsie/N Nyc Suburbs
New York · 31295
Office
$1724.50
Facility
$144.86
$62.64 higher than Austin for the office setting.
Queens
New York · 31295
Office
$1857.66
Facility
$152.52
$195.80 higher than Austin for the office setting.
Rest Of New York
New York · 31295
Office
$1499.82
Facility
$129.37
$162.04 lower than Austin for the office setting.
Ohio
Ohio · 31295
Office
$1449.16
Facility
$132.08
$212.70 lower than Austin for the office setting.
Oklahoma
Oklahoma · 31295
Office
$1416.62
Facility
$128.39
$245.24 lower than Austin for the office setting.
Portland
Oregon · 31295
Office
$1739.50
Facility
$136.79
$77.64 higher than Austin for the office setting.
Rest Of Oregon
Oregon · 31295
Office
$1567.75
Facility
$130.93
$94.11 lower than Austin for the office setting.
Metropolitan Philadelphia
Pennsylvania · 31295
Office
$1642.16
Facility
$140.43
$19.70 lower than Austin for the office setting.
Rest Of Pennsylvania
Pennsylvania · 31295
Office
$1455.72
Facility
$131.43
$206.14 lower than Austin for the office setting.
Puerto Rico
Puerto Rico · 31295
Office
$1593.57
Facility
$135.12
$68.29 lower than Austin for the office setting.
Rhode Island
Rhode Island · 31295
Office
$1626.52
Facility
$136.33
$35.34 lower than Austin for the office setting.
South Carolina
South Carolina · 31295
Office
$1463.34
Facility
$130.40
$198.52 lower than Austin for the office setting.
South Dakota**
South Dakota · 31295
Office
$1568.88
Facility
$126.29
$92.98 lower than Austin for the office setting.
Tennessee
Tennessee · 31295
Office
$1437.12
Facility
$125.81
$224.74 lower than Austin for the office setting.
Utah
Utah · 31295
Office
$1487.60
Facility
$131.57
$174.26 lower than Austin for the office setting.
Virginia
Virginia · 31295
Office
$1548.59
Facility
$130.53
$113.27 lower than Austin for the office setting.
Virgin Islands
United States Virgin Islands · 31295
Office
$1593.57
Facility
$135.12
$68.29 lower than Austin for the office setting.
Vermont
Vermont · 31295
Office
$1556.32
Facility
$128.16
$105.54 lower than Austin for the office setting.
Rest Of Washington
Washington · 31295
Office
$1653.82
Facility
$134.77
$8.04 lower than Austin for the office setting.
Seattle (King Cnty)
Washington · 31295
Office
$1914.73
Facility
$144.68
$252.87 higher than Austin for the office setting.
Wisconsin
Wisconsin · 31295
Office
$1506.49
Facility
$124.49
$155.37 lower than Austin for the office setting.
West Virginia
West Virginia · 31295
Office
$1389.70
Facility
$136.09
$272.16 lower than Austin for the office setting.
Wyoming**
Wyoming · 31295
Office
$1574.14
Facility
$131.55
$87.72 lower than Austin for the office setting.
See how rates vary across the country
31295 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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.
$1,363.00
$1,974.28
Color shows the midpoint of each state’s locality range.
View all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | $1,711.58 | 1 |
| AL | $1,387.29 | 1 |
| AR | $1,363.00 | 1 |
| AZ | $1,529.87 | 1 |
| CA | $1,714.73–$2,233.82 | 29 |
| CO | $1,670.23 | 1 |
| CT | $1,695.72 | 1 |
| DC | $1,846.58 | 1 |
| DE | $1,558.93 | 1 |
| FL | $1,519.10–$1,657.98 | 3 |
| GA | $1,420.55–$1,604.03 | 2 |
| GU | $1,774.34 | 1 |
| HI | $1,774.34 | 1 |
| IA | $1,444.15 | 1 |
| ID | $1,452.53 | 1 |
| IL | $1,456.39–$1,628.07 | 4 |
| IN | $1,463.03 | 1 |
| KS | $1,429.30 | 1 |
| KY | $1,412.51 | 1 |
| LA | $1,407.16–$1,492.17 | 2 |
| MA | $1,654.55–$1,866.16 | 2 |
| MD | $1,595.05–$1,846.58 | 3 |
| ME | $1,454.47–$1,559.43 | 2 |
| MI | $1,450.74–$1,534.78 | 2 |
| MN | $1,611.18 | 1 |
| MO | $1,373.41–$1,506.67 | 3 |
| MS | $1,368.87 | 1 |
| MT | $1,577.50 | 1 |
| NC | $1,473.89 | 1 |
| ND | $1,569.79 | 1 |
| NE | $1,455.72 | 1 |
| NH | $1,636.44 | 1 |
| NJ | $1,718.15–$1,820.21 | 2 |
| NM | $1,457.58 | 1 |
| NV | $1,576.83 | 1 |
| NY | $1,499.82–$1,873.40 | 5 |
| OH | $1,449.16 | 1 |
| OK | $1,416.62 | 1 |
| OR | $1,567.75–$1,739.50 | 2 |
| PA | $1,455.72–$1,642.16 | 2 |
| PR | $1,593.57 | 1 |
| RI | $1,626.52 | 1 |
| SC | $1,463.34 | 1 |
| SD | $1,568.88 | 1 |
| TN | $1,437.12 | 1 |
| TX | $1,443.70–$1,661.86 | 8 |
| UT | $1,487.60 | 1 |
| VA | $1,548.59–$1,846.58 | 2 |
| VI | $1,593.57 | 1 |
| VT | $1,556.32 | 1 |
| WA | $1,653.82–$1,914.73 | 2 |
| WI | $1,506.49 | 1 |
| WV | $1,389.70 | 1 |
| WY | $1,574.14 | 1 |
Where does this rate apply?
Austin is a Medicare payment area. Our Census mapping connects it to 31 cities and communities in Texas, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
- 31295 in Austin
Multiple payment areas
- 31295 in Barton Creek
- 31295 in Bee Cave
- 31295 in Briarcliff
- 31295 in Cedar Park
Multiple payment areas
- 31295 in Creedmoor
Multiple payment areas
- 31295 in Elgin
Multiple payment areas
- 31295 in Garfield
Why are the office and facility amounts different?
For 31295 in Austin, the physician’s office rate is $1661.86 and the facility-setting rate is $135.61: a difference of $1526.25.
The calculation uses a different practice-expense RVU for each setting. Both amounts here are physician fee-schedule amounts. The facility figure does not include a hospital’s separate charges, so this comparison does not tell you the total cost of receiving care in each setting.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 31295 in Austin. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$1828.05
$1661.86 × 110% = $1828.05
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 31295 in Austin.
PPRRVU2026_Oct_nonQPP.csv
3,550
- Code
- 31295
- Physician work
- 2.63
- Practice expense
- 44.21
- Malpractice
- 0.39
GPCI2026.csv
96
- Locality
- Austin
- Physician work
- 1.002
- Practice expense
- 1.058
- Malpractice
- 0.886
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.63 | × 1.002 | 2.6353 |
| Practice expense | 44.21 | × 1.058 | 46.7742 |
| Malpractice | 0.39 | × 0.886 | 0.3455 |
| Total RVUs | 49.7550 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Austin$1661.86
Open 31295 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.63 | 1.002 |
| Practice expense | 44.21 | 1.058 |
| Malpractice | 0.39 | 0.886 |
(2.63 × 1.002 + 44.21 × 1.058 + 0.39 × 0.886) × $33.4009 = $1661.86
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.63 | 1.002 |
| Practice expense | 1.02 | 1.058 |
| Malpractice | 0.39 | 0.886 |
(2.63 × 1.002 + 1.02 × 1.058 + 0.39 × 0.886) × $33.4009 = $135.61
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
31295 · Office / nonfacility
$1661.86
Effective 2026-10-01
The base rate is $75.63 higher than on 2025-10-01, moving from $1586.23 to $1661.86 (4.8%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$1586.23changed to$1661.86
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 2.70 changed to 2.63
- Practice expense RVU 43.96 changed to 44.21
- Work GPCI 1.000 changed to 1.002
- Practice expense GPCI 1.046 changed to 1.058
- Malpractice GPCI 0.914 changed to 0.886
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
Earliest loaded release: $1586.23
Held through RVU25B, RVU25C, RVU25D.
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $1661.86 | $135.61 | RVU26D |
| 2026-07-01 | $1661.86 | $135.61 | RVU26C |
| 2026-04-01 | $1661.86 | $135.61 | RVU26B |
| 2026-01-01 | $1661.86 | $135.61 | RVU26A |
| 2025-10-01 | $1586.23 | $154.69 | RVU25D |
| 2025-07-01 | $1586.23 | $154.69 | RVU25C |
| 2025-04-01 | $1586.23 | $154.69 | RVU25B |
| 2025-01-01 | $1586.23 | $154.69 | RVU25A |
31295 billing questions
How does this differ from 31256?
31295 describes balloon dilation of the maxillary sinus opening. Code 31256 is used for a conventional endoscopic maxillary sinus exploration and opening rather than balloon dilation.
When would 31267 be a better fit?
Use 31267 when the maxillary sinus procedure includes removal of tissue. Balloon dilation of the ostium without that tissue removal is the distinguishing service for 31295.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure: report modifier 50 for bilateral treatment. CMS pays the bilateral service at 150%.
What happens when another sinus endoscopy is performed during the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The operative report should identify each sinus procedure performed.
Is same-day postoperative care separately included in the global period?
No. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant surgeon be reported?
CMS may pay for an assistant at surgery. Co-surgeons and team surgery are not permitted for this service under the supplied CMS rules.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,54731292,,Nsl/sins ndsc med/inf dcmprn,A,,15.50,7.80,NA,7.80,,2.28,25.58,25.58,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54831293,,Nsl/sins ndsc med&inf dcmprn,A,,17.03,8.12,NA,8.12,,2.49,27.64,27.64,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54931294,,Nsl/sins ndsc surg on dcmprn,A,,19.80,8.80,NA,8.80,,2.90,31.50,31.50,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55031295,,Nsl/sins ndsc surg max sins,A,,2.63,44.21,,1.02,,0.39,47.23,4.04,0,000,0.00,0.00,0.00,3,1,2,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55131296,,Nsl/sins ndsc surg frnt sins,A,,3.02,44.55,,1.11,,0.43,48.00,4.56,0,000,0.00,0.00,0.00,3,1,2,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55231297,,Nsl/sins ndsc surg sphn sins,A,,2.38,44.10,,0.96,,0.36,46.84,3.70,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55331298,,Nsl/sins ndsc surg frnt&sphn,A,,4.39,83.78,,1.45,,0.62,88.79,6.46,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537
9604412,TX,31,AUSTIN,1.002,1.058,0.886
9704412,TX,20,BEAUMONT,1.000,0.910,0.929
9804412,TX,09,BRAZORIA,1.008,0.991,0.780
9904412,TX,11,DALLAS,1.009,0.996,0.858