No office rate
31287 covers sphenoidotomy without tissue removal from the sphenoid sinus. Choose 31288 when the surgeon also removes tissue from that sinus.
On this page
CMS RVU26D · Effective 2026-10-01
31288 Sphenoid surgery Medicare reimbursement rates in Colorado
Report this endoscopic sphenoid sinus operation when the surgeon opens the sinus and removes tissue, such as a polyp or diseased tissue. Compare 31288 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 31288 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
$198.31
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/sinus surgery
About 31288: Sphenoidotomy with tissue removal
Report this endoscopic sphenoid sinus operation when the surgeon opens the sinus and removes tissue, such as a polyp or diseased tissue.
An otolaryngologist typically performs this endoscopic operation through the nasal passage to open the sphenoid sinus and remove tissue from within it. It may be performed for sphenoid disease when tissue, such as a polyp or diseased mucosa, is removed as part of the sinus procedure. The operative note should identify the sphenoid sinus treated, describe the opening and tissue removal, and record laterality and any additional sinus procedures.
Select this code when the sphenoid procedure includes tissue removal; a sphenoidotomy without tissue removal is a different service. CMS applies endoscopy-family pricing when related endoscopies are performed together. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. For a bilateral procedure, modifier 50 is paid at 150%. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 31288
- 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 RVU4.00 · 67%
- Practice expense (office) RVU1.35 · 23%
- Malpractice RVU0.58 · 10%
2.9K
Medicare services in 2024 · #2204 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.
31288 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
31259 includes total ethmoidectomy along with sphenoidotomy and sphenoid tissue removal. Use 31288 for the sphenoid procedure without that included total ethmoidectomy.
No office rate
31257 includes total ethmoidectomy and sphenoidotomy without sphenoid tissue removal. Code 31288 describes sphenoid tissue removal without the included ethmoidectomy.
No office rate
31267 applies to maxillary sinus surgery with tissue removal; 31288 is for tissue removal from the sphenoid sinus.
Compare 31288 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
$198.31
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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 31288 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
3,544
- Code
- 31288
- Physician work
- 4.00
- Practice expense
- 1.35
- Malpractice
- 0.58
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.00 | × 1.012 | 4.0480 |
| Practice expense | 1.35 | × 1.064 | 1.4364 |
| Malpractice | 0.58 | × 0.781 | 0.4530 |
| Total RVUs | 5.9374 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$198.31
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4 | 1.012 |
| Practice expense | 1.35 | 1.064 |
| Malpractice | 0.58 | 0.781 |
(4 × 1.012 + 1.35 × 1.064 + 0.58 × 0.781) × $33.4009 = $198.31
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.
31288 billing questions
How does this differ from 31287?
Use 31288 when tissue is removed from the sphenoid sinus during the endoscopic procedure. Code 31287 describes sphenoidotomy without tissue removal.
Can an ethmoidectomy also be reported?
A separately performed ethmoidectomy may be reported when supported by the operative documentation. When related endoscopies are performed together, CMS endoscopy-family pricing applies.
What supports reporting tissue removal?
The operative report should document tissue removal from the sphenoid sinus, along with the sinus treated and the surgical work performed. A sinus opening alone does not support the tissue-removal distinction.
How is a bilateral procedure reported?
Report modifier 50 for a bilateral procedure. CMS pays the bilateral procedure at 150%.
Is same-day postoperative care included?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of medical necessity. CMS does not permit co-surgeons or team surgery for this code.
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.
3,5413126F,,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
3,54431288,,Nasal/sinus endoscopy surg,A,,4.00,1.35,NA,1.35,,0.58,5.93,5.93,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54531290,,Nasal/sinus endoscopy surg,A,,18.14,8.73,NA,8.73,,2.84,29.71,29.71,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54631291,,Nasal/sinus endoscopy surg,A,,19.07,9.50,NA,9.50,,3.67,32.24,32.24,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54731292,,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
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