No office rate
31256 covers maxillary sinus endoscopy without tissue removal from inside the sinus. Choose 31267 when that tissue removal is documented.
On this page
CMS RVU26D · Effective 2026-10-01
31267 Sinus endoscopy Medicare reimbursement rates in Colorado
Reports endoscopic maxillary sinus surgery that opens the sinus and removes tissue from within it, such as polypoid or diseased tissue. Compare 31267 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 31267 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
No supported rate
Facility setting
$224.31
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 and sinus surgery
About 31267: Maxillary sinus endoscopy with tissue removal
Reports endoscopic maxillary sinus surgery that opens the sinus and removes tissue from within it, such as polypoid or diseased tissue.
An otolaryngologist or rhinologist performs this endoscopic operation to access the maxillary sinus, enlarge its opening, and remove tissue from inside the sinus. Typical clinical situations include chronic maxillary sinus disease with polyps or other obstructive tissue. The operative report should establish that tissue was removed from the maxillary sinus, not merely from the nasal cavity or the sinus opening. The service is performed in an office or facility setting, depending on the case and where the surgery takes place.
Report the code when the operative work includes both maxillary sinus access and tissue removal from that sinus; an opening without tissue removal is a different service. Document the side, endoscopic work, tissue removed, and any other sinus procedures performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral surgery, modifier 50 is paid at 150%. When related endoscopies are performed together, endoscopy family pricing applies. CMS does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
CMS billing rules for 31267
- 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 RVU4.56 · 68%
- Practice expense (office) RVU1.49 · 22%
- Malpractice RVU0.66 · 10%
24.8K
Medicare services in 2024 · #1052 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.
31267 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
31276 represents endoscopic frontal sinus surgery with tissue removal. The sinus treated, rather than the general use of endoscopy, distinguishes it from 31267.
No office rate
31288 represents endoscopic sphenoid sinus surgery with tissue removal. Use 31267 for the corresponding maxillary sinus work.
Compare 31267 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
Unavailable
Facility
$224.31
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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 31267 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
3,540
- Code
- 31267
- Physician work
- 4.56
- Practice expense
- 1.49
- Malpractice
- 0.66
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.56 | × 1.012 | 4.6147 |
| Practice expense | 1.49 | × 1.064 | 1.5854 |
| Malpractice | 0.66 | × 0.781 | 0.5155 |
| Total RVUs | 6.7155 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$224.31
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.56 | 1.012 |
| Practice expense | 1.49 | 1.064 |
| Malpractice | 0.66 | 0.781 |
(4.56 × 1.012 + 1.49 × 1.064 + 0.66 × 0.781) × $33.4009 = $224.31
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.
31267 billing questions
How does this differ from 31256?
Use 31267 when tissue is removed from within the maxillary sinus as part of the endoscopic work. 31256 represents maxillary sinus access without that tissue removal.
Does tissue removed from the nasal cavity qualify?
No. The documentation should identify tissue removed from inside the maxillary sinus; removal limited to the nasal cavity or sinus opening does not establish that work.
How is bilateral surgery reported?
CMS identifies this as a bilateral procedure. Report modifier 50 for bilateral surgery; CMS pays it at 150%.
Can another related sinus endoscopy be reported at the same session?
A separate endoscopic procedure may be reported when the operative work supports it at another sinus site. CMS endoscopy family pricing applies when related endoscopies are performed together.
What is the global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. 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 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.
3,53731256,,Exploration maxillary sinus,A,,3.03,1.11,NA,1.11,,0.43,4.57,4.57,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53831257,,Nsl/sins ndsc tot w/sphendt,A,,7.80,2.29,NA,2.29,,1.14,11.23,11.23,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53931259,,Nsl/sins ndsc sphn tiss rmvl,A,,8.27,2.40,NA,2.40,,1.22,11.89,11.89,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54031267,,Endoscopy maxillary sinus,A,,4.56,1.49,NA,1.49,,0.66,6.71,6.71,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,5413126F,,Esoph bx rprt w/dyspl info,M,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3,54231276,,Nsl/sins ndsc frnt tiss rmvl,A,,6.58,1.98,NA,1.98,,0.96,9.52,9.52,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54331287,,Nasal/sinus endoscopy surg,A,,3.41,1.21,NA,1.21,,0.48,5.10,5.10,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
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