No office rate
Choose 31225 when the maxilla is removed without orbital exenteration. Code 31230 represents removal of both the maxilla and orbital contents.
On this page
CMS RVU26D · Effective 2026-10-01
31230 Maxillectomy Medicare reimbursement rates in Connecticut
Extensive oncologic resection removing the maxilla and orbital contents, reported when disease requires maxillectomy with orbital exenteration. Compare 31230 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 31230 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
$1841.10
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 31230: Maxillectomy with orbital exenteration
Extensive oncologic resection removing the maxilla and orbital contents, reported when disease requires maxillectomy with orbital exenteration.
Code 31230 represents an extensive resection in which the surgeon removes the upper jaw (maxilla) and the contents of the orbit. It is most often used for locally advanced maxillary sinus or adjacent sinonasal malignancy extending into the orbit, when treatment requires removal of both structures. An otolaryngologist or head-and-neck oncologic surgeon typically performs the operation in a surgical setting.
Report this code when the operative report supports removal of both the maxilla and orbital contents; maxillectomy without orbital exenteration points to 31225. Document the indication, side, and structures removed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and others 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 is not permitted.
CMS billing rules for 31230
- 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 RVU30.05 · 58%
- Practice expense (office) RVU17.80 · 34%
- Malpractice RVU4.38 · 8%
33
Medicare services in 2024 · #5595 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.
31230 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
65110 represents orbital exenteration without the combined maxillectomy. When the same operation removes the maxilla and orbital contents, 31230 describes the combined resection.
No office rate
65112 describes orbital exenteration with an implant, rather than maxillectomy with orbital exenteration. Use 31230 when both the maxilla and orbital contents are removed.
Compare 31230 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
$1841.10
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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 31230 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
3,523
- Code
- 31230
- Physician work
- 30.05
- Practice expense
- 17.80
- Malpractice
- 4.38
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 30.05 | × 1.020 | 30.6510 |
| Practice expense | 17.80 | × 1.077 | 19.1706 |
| Malpractice | 4.38 | × 1.210 | 5.2998 |
| Total RVUs | 55.1214 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$1841.10
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 30.05 | 1.02 |
| Practice expense | 17.8 | 1.077 |
| Malpractice | 4.38 | 1.21 |
(30.05 × 1.02 + 17.8 × 1.077 + 4.38 × 1.21) × $33.4009 = $1841.10
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.
31230 billing questions
How does 31230 differ from 31225?
31230 includes removal of orbital contents along with the maxilla. Use 31225 when the maxilla is removed without orbital exenteration.
Can an orbital exenteration code also be reported?
31230 includes orbital exenteration as part of the maxillectomy. Do not report a separate orbital exenteration code for the same removal of orbital contents.
How is bilateral surgery reported?
CMS identifies this as a bilateral procedure and pays modifier 50 at 150%. Document the procedure on each side.
What documentation supports 31230?
The operative report should identify the indication and confirm removal of both the maxilla and orbital contents, including the side or sides treated.
How does the global period affect postoperative billing?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
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.
3,52031205,,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
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
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