CPT code 31257: Sinus endoscopy2026 Medicare rate & RVUs in Florida
Reports endoscopic removal of anterior and posterior ethmoid tissue with an opening into the sphenoid sinus during surgical treatment of chronic sinus disease.
CMS doesn’t publish an office rate for 31257 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 31257 covers
An otolaryngologist performs this endoscopic operation to remove ethmoid air-cell tissue from both the anterior and posterior portions of the ethmoid sinus and create an opening into the sphenoid sinus. It may be part of surgery for chronic rhinosinusitis when disease involves both sinus regions. The sphenoid sinus is opened, but removal of tissue from within that sinus is not part of this code’s distinguishing service.
Select the code when the operative report supports the complete ethmoidectomy and sphenoidotomy; distinguish it from a sphenoid procedure that also removes sphenoid tissue. Document the treated sides and the work performed in each sinus. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. For bilateral reporting, modifier 50 is paid at 150%. Medicare does not pay for an assistant at surgery, and co-surgeons and team surgery are not permitted.
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.
Where 31257 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $406.85 |
| Miami | Unavailable | $436.45 |
| Rest Of Florida | Unavailable | $390.88 |
How the 31257 rate is calculated
Each of 31257’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 31257
RVUs × geographic indexes × conversion factor
Work7.80
7.80 RVUs× 1.000 GPCI
Practice expense2.29
2.29 RVUs× 1.000 GPCI
Malpractice1.14
1.14 RVUs× 1.000 GPCI
Adjusted RVUs
11.2300
Conversion factor
$33.4009
Medicare rate
$375.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31257
The CMS indicators that decide how 31257 is paid alongside other services.
CMS payment indicators · 31257
Sinus endoscopy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
31257 without 50 · national facility
$375.09
Sinus endoscopy
31257-50 · Bilateral: 150%
$562.63
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
31257 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 31255Ethmoidectomy
- 31255 represents total ethmoidectomy without sphenoidotomy. Choose 31257 when the surgeon also creates an opening into the sphenoid sinus.
- 31259Sinus endoscopy
- 31259 includes removal of tissue from within the sphenoid sinus; 31257 describes sphenoidotomy without that tissue-removal element.
- 31287Sphenoidotomy
- 31287 covers sphenoidotomy without total ethmoidectomy. Use 31257 when the surgeon performs both sphenoidotomy and total ethmoidectomy.
- 31253Sinus endoscopy
- 31253 pairs total ethmoidectomy with frontal sinus work. Code 31257 pairs total ethmoidectomy with sphenoidotomy instead.
31257 billing questions
How is this different from 31259?
31259 includes removal of tissue from the sphenoid sinus in addition to the total ethmoidectomy and sphenoidotomy. Use 31257 when the sphenoid sinus is opened but sphenoid tissue removal is not performed.
Can 31255 be reported with 31257 for the same ethmoidectomy?
31257 already includes total ethmoidectomy. Do not separately report 31255 for that same ethmoid work.
What documentation supports reporting 31257?
The operative report should establish removal of anterior and posterior ethmoid tissue and creation of an opening into the sphenoid sinus. Document the side or sides treated and whether tissue was removed from within the sphenoid sinus.
How should bilateral surgery be reported?
Report bilateral surgery with modifier 50. CMS pays the bilateral procedure at 150%.
Can an assistant surgeon or co-surgeon be billed?
CMS does not pay for an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What happens when other related sinus endoscopies are performed in the same session?
Endoscopy family pricing applies when related endoscopies are performed together. The 0-day global period includes same-day preoperative and 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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