No office rate
31254 is for partial ethmoidectomy, generally anterior. 31255 is for total ethmoidectomy.
On this page
CMS RVU26D · Effective 2026-10-01
31254 Ethmoidectomy Medicare reimbursement rates in Connecticut
Reports endoscopic removal of part of the anterior ethmoid air cells during surgery for ethmoid sinus disease, rather than complete ethmoidectomy. Compare 31254 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 31254 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
$464.91
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$216.34
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.
Nasal and sinus surgery
About 31254: Endoscopic partial ethmoidectomy
Reports endoscopic removal of part of the anterior ethmoid air cells during surgery for ethmoid sinus disease, rather than complete ethmoidectomy.
An otolaryngologist uses a nasal endoscope and surgical instruments to remove part of the ethmoid air cells, typically the anterior portion, to treat disease such as chronic inflammation or obstructed drainage. The procedure is commonly performed in a hospital outpatient department or ambulatory surgery center. The extent is partial: complete ethmoid cell removal belongs to a different code. The operative report should identify the treated side, the ethmoid work performed, and the extent of tissue or partitions removed.
Report this code when the surgeon performs partial endoscopic ethmoidectomy, not for diagnostic nasal inspection alone. When related nasal or sinus endoscopies are performed together, CMS endoscopy-family pricing applies. For bilateral surgery, modifier 50 is paid at 150%. The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 31254
- 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 RVU4.16 · 32%
- Practice expense (office) RVU8.31 · 64%
- Malpractice RVU0.60 · 5%
11.1K
Medicare services in 2024 · #1420 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.
31254 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
31253 describes total ethmoidectomy combined with frontal sinus surgery; 31254 is partial ethmoidectomy without that combined service.
$206.96
31231 is diagnostic nasal endoscopy. It does not represent surgical removal of ethmoid cells.
No office rate
31256 reports endoscopic maxillary sinus exploration, not ethmoidectomy. Select based on the sinus actually treated.
Compare 31254 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
$464.91
Facility
$216.34
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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 31254 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
3,535
- Code
- 31254
- Physician work
- 4.16
- Practice expense
- 8.31
- Malpractice
- 0.60
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.16 | × 1.020 | 4.2432 |
| Practice expense | 8.31 | × 1.077 | 8.9499 |
| Malpractice | 0.60 | × 1.210 | 0.7260 |
| Total RVUs | 13.9191 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$464.91
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.16 | 1.02 |
| Practice expense | 8.31 | 1.077 |
| Malpractice | 0.6 | 1.21 |
(4.16 × 1.02 + 8.31 × 1.077 + 0.6 × 1.21) × $33.4009 = $464.91
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 4.16 | 1.02 |
| Practice expense | 1.4 | 1.077 |
| Malpractice | 0.6 | 1.21 |
(4.16 × 1.02 + 1.4 × 1.077 + 0.6 × 1.21) × $33.4009 = $216.34
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.
31254 billing questions
How does this differ from 31255?
31254 describes partial ethmoidectomy, generally involving the anterior ethmoid cells. Use 31255 when the surgeon performs total ethmoidectomy.
Can this be reported with maxillary or frontal sinus surgery?
A surgeon may perform separately indicated work in other sinuses during the same operation. CMS endoscopy-family pricing applies when related endoscopies are performed together.
How is bilateral surgery reported?
Report bilateral surgery with modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports the partial ethmoidectomy?
The operative report should describe the endoscopic ethmoid work, identify the side, and make clear that the removal was partial rather than total.
Can an assistant surgeon or co-surgeon be billed?
Medicare 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.
3,53231242,,Nsl/sinus ndsc rf abltj pnn,A,,2.63,68.70,,1.02,,0.39,71.72,4.04,0,000,0.00,0.00,0.00,3,2,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53331243,,Nsl/sinus ndsc cryoabltj pnn,A,,2.63,66.62,,1.02,,0.39,69.64,4.04,0,000,0.00,0.00,0.00,3,2,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53431253,,Nsl/sins ndsc total,A,,8.78,2.51,NA,2.51,,1.29,12.58,12.58,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53531254,,Nsl/sins ndsc w/prtl ethmdct,A,,4.16,8.31,,1.40,,0.60,13.07,6.16,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53631255,,Nsl/sins ndsc w/tot ethmdct,A,,5.61,1.75,NA,1.75,,0.82,8.18,8.18,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53731256,,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
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