No office rate
Both involve maxillectomy. Choose 31225 when the orbital contents are preserved; 31230 is the relevant comparison when they are removed.
On this page
CMS RVU26D · Effective 2026-10-01
31225 Maxillectomy Medicare reimbursement rates in Connecticut
Reports surgical removal of maxillary bone while preserving the orbital contents, commonly for a tumor or destructive lesion requiring upper-jaw resection. Compare 31225 office and facility rates across CMS payment localities in Connecticut.
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 31225 in Connecticut?
Connecticut 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
$1666.32
1 of 1 localities have a supported rate.
Payment area: Connecticut
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.
Head and neck surgery
About 31225: Maxillectomy without orbital exenteration
Reports surgical removal of maxillary bone while preserving the orbital contents, commonly for a tumor or destructive lesion requiring upper-jaw resection.
This service involves removing part or all of the maxilla—the bone forming the upper jaw—without removing the contents of the eye socket. It is typically performed by an otolaryngologist or head and neck surgeon in an operating room when a tumor or other destructive lesion requires resection beyond removal of sinus lining or contents. The operative report should make clear that maxillary bone was removed and whether the orbital contents were preserved.
Report this code for the maxillectomy itself, not an endoscopic maxillary sinus procedure limited to opening the sinus or removing tissue within it. If the orbital contents are removed, compare the procedure with 31230. CMS assigns a 90-day major-surgery global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures at 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team-surgery payment is not permitted.
CMS billing rules for 31225
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU26.03 · 55%
- Practice expense (office) RVU17.40 · 37%
- Malpractice RVU3.80 · 8%
1K
Medicare services in 2024 · #2962 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.
31225 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
31256 describes endoscopic opening of the maxillary sinus without the maxillary bone resection represented by 31225.
No office rate
31267 describes endoscopic maxillary sinus surgery that includes tissue removal. It is not a substitute for a maxillectomy involving removal of upper-jaw bone.
Compare 31225 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$1666.32
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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 31225 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
3,522
- Code
- 31225
- Physician work
- 26.03
- Practice expense
- 17.40
- Malpractice
- 3.80
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 26.03 | × 1.020 | 26.5506 |
| Practice expense | 17.40 | × 1.077 | 18.7398 |
| Malpractice | 3.80 | × 1.210 | 4.5980 |
| Total RVUs | 49.8884 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$1666.32
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 26.03 | 1.02 |
| Practice expense | 17.4 | 1.077 |
| Malpractice | 3.8 | 1.21 |
(26.03 × 1.02 + 17.4 × 1.077 + 3.8 × 1.21) × $33.4009 = $1666.32
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.
31225 billing questions
How is this distinguished from 31230?
Use 31225 when the maxillectomy preserves the orbital contents. When the operation removes the contents of the eye socket, compare it with 31230.
Is an endoscopic maxillary sinus procedure reported with this code?
Not for the same work: this code represents resection of maxillary bone, while 31256 and 31267 describe endoscopic work within the maxillary sinus. Base code selection on the documented procedure and extent.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
How are other procedures in the same session paid?
CMS pays the highest-valued procedure in full and reduces the other procedures to 50% when they are performed in the same session.
How is bilateral maxillectomy reported?
CMS identifies this as a bilateral procedure; reporting modifier 50 results in payment at 150%.
What documentation supports assistant or co-surgeon payment?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; CMS does not permit team-surgery payment.
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.
3,51931201,,Removal of ethmoid sinus,A,,8.39,11.62,NA,11.62,,1.23,21.24,21.24,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52031205,,Removal of ethmoid sinus,A,,10.32,13.94,NA,13.94,,0.92,25.18,25.18,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,5213120F,,12-lead ecg performed,I,,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
3,52231225,,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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808