$202.40
Choose 31231 for diagnostic inspection confined to the nasal cavity. Choose 31233 when the endoscope enters the maxillary sinus for diagnostic visualization.
On this page
CMS RVU26D · Effective 2026-10-01
31233 Sinus endoscopy Medicare reimbursement rates in Colorado
Reports diagnostic endoscopic inspection of the maxillary sinus through the nasal passage when the clinician evaluates disease within that sinus. Compare 31233 office and facility rates across CMS payment localities in Colorado.
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 31233 in Colorado?
Colorado 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
$283.46
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$118.21
1 of 1 localities have a supported rate.
Payment area: Colorado
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.
Nasal endoscopy
About 31233: Diagnostic maxillary sinus endoscopy
Reports diagnostic endoscopic inspection of the maxillary sinus through the nasal passage when the clinician evaluates disease within that sinus.
An otolaryngologist or rhinologist passes an endoscope through the nasal cavity and into the maxillary sinus through its natural opening to inspect the sinus. The examination may help evaluate suspected maxillary sinus disease, such as persistent symptoms or an abnormal finding that requires direct visualization. This is distinct from an examination confined to the nasal cavity and from operative enlargement of the sinus opening or removal of tissue.
Report the service when the maxillary sinus is entered and diagnostically examined; document the approach, side or sides examined, and relevant findings. The code has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral reporting, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 31233
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.13 · 26%
- Practice expense (office) RVU5.73 · 70%
- Malpractice RVU0.30 · 4%
3.8K
Medicare services in 2024 · #2029 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.
31233 compared with similar codes
Office rates for Colorado, from the same CMS release.
$322.19
Both are diagnostic sinus endoscopy services, but 31235 targets the sphenoid sinus; 31233 targets the maxillary sinus.
No office rate
31256 is an operative maxillary sinus procedure that opens the sinus; 31233 is a diagnostic examination through the natural opening.
No office rate
31267 describes operative maxillary sinus endoscopy with tissue removal. Use 31233 for diagnostic inspection without that operative tissue-removal service.
Compare 31233 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
Colorado →
Office / nonfacility
$283.46
Facility
$118.21
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 31233 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
3,525
- Code
- 31233
- Physician work
- 2.13
- Practice expense
- 5.73
- Malpractice
- 0.30
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.13 | × 1.012 | 2.1556 |
| Practice expense | 5.73 | × 1.064 | 6.0967 |
| Malpractice | 0.30 | × 0.781 | 0.2343 |
| Total RVUs | 8.4866 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$283.46
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.13 | 1.012 |
| Practice expense | 5.73 | 1.064 |
| Malpractice | 0.3 | 0.781 |
(2.13 × 1.012 + 5.73 × 1.064 + 0.3 × 0.781) × $33.4009 = $283.46
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.13 | 1.012 |
| Practice expense | 1.08 | 1.064 |
| Malpractice | 0.3 | 0.781 |
(2.13 × 1.012 + 1.08 × 1.064 + 0.3 × 0.781) × $33.4009 = $118.21
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.
31233 billing questions
How does this differ from 31231?
31231 describes diagnostic nasal endoscopy limited to the nasal cavity. Use 31233 when the scope is advanced into and used to inspect the maxillary sinus.
How does this differ from 31235?
31235 is the diagnostic endoscopic examination of the sphenoid sinus. Code 31233 is for diagnostic examination of the maxillary sinus.
Can 31233 be reported with another endoscopy code?
Related endoscopies may be performed together, but CMS endoscopy family pricing applies. Document the distinct anatomic sites and services performed.
How is bilateral work reported?
For bilateral performance, report modifier 50; CMS pays 31233 at 150%. Document examination of both maxillary sinuses.
Can 31233 be reported for a maxillary antrostomy?
No. A diagnostic examination through the natural sinus opening is different from operative creation or enlargement of an opening, such as the service represented by 31256.
What documentation supports 31233?
Record that the endoscope entered the maxillary sinus, the side examined, and the diagnostic findings. A note describing nasal-cavity inspection alone supports a different service.
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.
3,52231225,,Removal of upper jaw,A,,26.03,17.40,NA,17.40,,3.80,47.23,47.23,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52331230,,Removal of upper jaw,A,,30.05,17.80,NA,17.80,,4.38,52.23,52.23,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899