Billing code 31296: Sinus dilationMedicare rate & RVUs in Florida
Report this service for endoscopic dilation of a frontal sinus opening, commonly using a balloon to improve drainage without removing sinus tissue.
Medicare pays $1,545.00–$1,686.21 for 31296 in the office in Florida, from Rest Of Florida to Miami. Which amount applies depends on the service address.
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 31296 covers
An otolaryngologist typically performs this procedure by guiding an endoscope through the nose to the frontal sinus opening and dilating the ostium, often with a balloon catheter. It may be performed in an office or an operating room for a patient with frontal sinus drainage problems. The service is specific to the frontal sinus; dilation of a maxillary or sphenoid sinus is represented by a different site-specific code.
Report 31296 when the documented work is dilation of the frontal sinus ostium. The operative note should identify the treated sinus and side, describe the endoscopic dilation, and support the clinical need. It 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 treatment, modifier 50 is paid at 150%. An assistant at surgery may be paid; 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 31296 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.
3 payment localities
$1545.00 to $1686.21
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $1,634.19 | $164.39 |
| Miami | $1,686.21 | $175.79 |
| Rest Of Florida | $1,545.00 | $157.90 |
How the 31296 rate is calculated
Each of 31296’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 · 31296
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 3.02Practice expense 44.55Malpractice 0.43
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 31296
The CMS indicators that decide how 31296 is paid alongside other services.
CMS payment indicators · 31296
Sinus dilation
| 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) | 2 | Paid. |
| 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
31296 without 50 · national office
$1,603.24
Sinus dilation
31296-50 · Bilateral: 150%
$2,404.86
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).
31296 compared with similar codes
Compare codes
31296 vs 31295 vs 31297 vs 31298 vs 31276: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 31295Sinus dilation
- Choose 31295 for dilation of the maxillary sinus opening; 31296 is specific to the frontal sinus opening.
- 31297Sinus dilation
- Choose 31297 for dilation of the sphenoid sinus opening; 31296 is specific to the frontal sinus opening.
- 31298Sinus dilation
- 31298 describes dilation of both frontal and sphenoid sinus openings. Use 31296 when the documented dilation is limited to the frontal sinus.
- 31276Frontal sinus endoscopy
- 31276 describes frontal sinus exploration with tissue removal when performed. 31296 represents dilation of the frontal sinus opening, not tissue removal.
31296 billing questions
How is 31296 different from 31295 or 31297?
31296 is for dilation of the frontal sinus ostium. Codes 31295 and 31297 describe dilation at the maxillary and sphenoid sinuses, respectively.
When is modifier 50 appropriate?
Use modifier 50 when the frontal sinus dilation is performed bilaterally. CMS identifies bilateral payment at 150%.
Can 31296 be reported with another sinus endoscopy code?
Related endoscopies performed together are subject to endoscopy family pricing. The operative documentation should establish the distinct work and sinus sites treated.
Does the code include same-day postoperative care?
Yes. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid for this procedure. Co-surgeons and team surgery are not permitted under the CMS rules provided.
What should the operative note identify?
Document the frontal sinus side treated, the endoscopic dilation performed, and the clinical reason for opening the ostium. Distinguish dilation from procedures involving tissue removal.
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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