$172.03
This code includes biopsy, polypectomy, or debridement. Choose 31231 for diagnostic nasal endoscopy without those tissue-treatment services.
On this page
CMS RVU26D · Effective 2026-10-01
31237 Nasal endoscopy Medicare reimbursement rates in Alabama
Report this surgical nasal or sinus endoscopy when the physician biopsies tissue, removes a polyp, or debrides postoperative material under endoscopic guidance. Compare 31237 office and facility rates across CMS payment localities in Alabama.
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.
What does Medicare pay for 31237 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$240.01
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$127.78
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Otolaryngology
About 31237: Nasal endoscopy with tissue treatment
Report this surgical nasal or sinus endoscopy when the physician biopsies tissue, removes a polyp, or debrides postoperative material under endoscopic guidance.
An otolaryngologist typically performs this procedure in an office, ambulatory surgery center, or hospital. Through a nasal endoscope, the physician obtains a biopsy, removes a polyp, or clears material such as crusts, clots, or devitalized tissue. Debridement may be performed during follow-up after endoscopic sinus surgery; the documented service must support actual endoscopic tissue treatment rather than inspection alone.
Select the code based on the work performed, and document the treated site and side, the tissue action, and any specimen sent for pathology. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral work, modifier 50 is paid at 150%. When related endoscopies are performed together, endoscopy-family pricing applies. An assistant at surgery is not paid under the statutory restriction; co-surgeons and team surgery are not permitted.
CMS billing rules for 31237
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.54 · 32%
- Practice expense (office) RVU5.07 · 64%
- Malpractice RVU0.37 · 5%
85.6K
Medicare services in 2024 · #608 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.
31237 compared with similar codes
Office rates for Alabama, from the same CMS release.
$234.79
31238 is for endoscopic surgical control of nasal bleeding. Use 31237 for biopsy, polyp removal, or debridement rather than hemostasis as the primary work.
$393.16
31254 describes endoscopic partial ethmoidectomy. It represents sinus surgery on the ethmoid, not the biopsy, polypectomy, or debridement service described by this code.
No office rate
31267 describes endoscopic maxillary sinus surgery with tissue removal. Distinguish that sinus operation from a separately documented biopsy, polypectomy, or debridement service.
Compare 31237 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$240.01
Facility
$127.78
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 31237 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
3,527
- Code
- 31237
- Physician work
- 2.54
- Practice expense
- 5.07
- Malpractice
- 0.37
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.54 | × 1.000 | 2.5400 |
| Practice expense | 5.07 | × 0.875 | 4.4363 |
| Malpractice | 0.37 | × 0.566 | 0.2094 |
| Total RVUs | 7.1857 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$240.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.54 | 1 |
| Practice expense | 5.07 | 0.875 |
| Malpractice | 0.37 | 0.566 |
(2.54 × 1 + 5.07 × 0.875 + 0.37 × 0.566) × $33.4009 = $240.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.54 | 1 |
| Practice expense | 1.23 | 0.875 |
| Malpractice | 0.37 | 0.566 |
(2.54 × 1 + 1.23 × 0.875 + 0.37 × 0.566) × $33.4009 = $127.78
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.
31237 billing questions
When is this code appropriate instead of diagnostic nasal endoscopy?
Use this code when endoscopy includes a biopsy, polypectomy, or debridement. Inspection and evaluation without one of those therapeutic or tissue-sampling services may support a diagnostic endoscopy code instead.
Can this code describe postoperative sinus debridement?
Yes, when the physician performs endoscopic debridement, such as clearing crusts, clots, or devitalized tissue. Document the treated area and the work performed.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure. Report modifier 50 for bilateral work; CMS payment is 150%.
What happens when related endoscopies are performed together?
CMS applies endoscopy-family pricing when related endoscopies are performed together. The medical record should identify each procedure and its distinct purpose and site.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care. A debridement performed on a later date is not within that same-day global period.
Can an assistant surgeon or co-surgeon be reported?
An assistant at surgery is not paid under the statutory restriction. CMS does not permit co-surgeons or team surgery for this procedure.
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.
3,52431231,,Nasal endoscopy dx,A,,1.07,4.56,,0.41,,0.16,5.79,1.64,0,000,0.00,0.00,0.00,2,2,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52531233,,Nsl/sins ndsc dx max sinusc,A,,2.13,5.73,,1.08,,0.30,8.16,3.51,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52631235,,Nsl/sins ndsc dx sphn sinusc,A,,2.57,6.35,,1.19,,0.37,9.29,4.13,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52731237,,Nsl/sins ndsc surg bx polypc,A,,2.54,5.07,,1.23,,0.37,7.98,4.14,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52831238,,Nsl/sins ndsc srg nsl hemrrg,A,,2.67,4.73,,1.26,,0.39,7.79,4.32,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52931239,,Nsl/sinus endoscopy surg dcr,A,,8.81,5.91,NA,5.91,,0.99,15.71,15.71,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53031240,,Nsl/sns ndsc cnch bull rescj,A,,2.54,1.18,NA,1.18,,0.37,4.09,4.09,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515