$294.55
31231 inspects the nasal cavity and sinus openings without entering a sinus. 31233 includes direct examination inside the maxillary sinus.
On this page
CMS RVU26D · Effective 2026-10-01
31231 Nasal endoscopy Medicare reimbursement rates in Guam
Report diagnostic nasal endoscopy for endoscopic inspection of the nasal passages, meatuses, and sphenoethmoid recess without sinus entry or surgical treatment. Compare 31231 office and facility rates across CMS payment localities in Guam.
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 31231 in Guam?
Guam 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
$212.01
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
$54.40
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Otolaryngology procedure
About 31231: Diagnostic nasal endoscopy, unilateral or bilateral
Report diagnostic nasal endoscopy for endoscopic inspection of the nasal passages, meatuses, and sphenoethmoid recess without sinus entry or surgical treatment.
An otolaryngologist, and sometimes an allergist or advanced practice provider, uses a rigid or flexible scope to inspect the nasal cavity in an office or outpatient facility. Topical decongestant or anesthetic may be used. The examination can show the septum, turbinates, middle meatus, sphenoethmoid recess, and nasopharynx when visualized. Common indications include chronic rhinosinusitis, nasal obstruction, recurrent epistaxis, suspected polyps or masses, and surveillance after sinus surgery when no debridement is performed.
Report one unit whether one or both sides are examined; the code is already priced as bilateral, so modifier 50 adds no payment. Document the indication, sides examined, structures viewed, and findings. Its 0-day global period includes same-day pre- and post-procedure care. A separately identifiable E/M service beyond that care may be reported with modifier 25 on the E/M code. For multiple procedures in the same session, the highest-valued is paid in full and other procedures subject to the standard reduction are paid at 50%. Medicare does not pay an assistant at surgery or permit co-surgeons or team surgery for this code.
CMS billing rules for 31231
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is 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
- The code is already priced as bilateral; modifier 50 does not increase payment.
- 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 RVU1.07 · 18%
- Practice expense (office) RVU4.56 · 79%
- Malpractice RVU0.16 · 3%
739.4K
Medicare services in 2024 · #175 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.
31231 compared with similar codes
Office rates for Guam, from the same CMS release.
$284.54
Use 31237 when the nasal or sinus endoscopy includes biopsy, polyp removal, or debridement. Do not separately report 31231 for diagnostic inspection of the same site during that surgical endoscopy.
$128.33
92511 focuses on the nasopharynx. 31231 evaluates nasal cavity structures such as the meatuses, turbinates, and sphenoethmoid recess, even if the nasopharynx is also visualized.
$138.06
31575 examines the larynx with a flexible scope. Passing that scope through the nose does not alone support 31231; a separate medically necessary nasal cavity examination must be documented.
Compare 31231 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
Hawaii, Guam →
Office / nonfacility
$212.01
Facility
$54.40
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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 31231 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
3,524
- Code
- 31231
- Physician work
- 1.07
- Practice expense
- 4.56
- Malpractice
- 0.16
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.07 | × 1.000 | 1.0700 |
| Practice expense | 4.56 | × 1.137 | 5.1847 |
| Malpractice | 0.16 | × 0.579 | 0.0926 |
| Total RVUs | 6.3474 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$212.01
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.07 | 1 |
| Practice expense | 4.56 | 1.137 |
| Malpractice | 0.16 | 0.579 |
(1.07 × 1 + 4.56 × 1.137 + 0.16 × 0.579) × $33.4009 = $212.01
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.07 | 1 |
| Practice expense | 0.41 | 1.137 |
| Malpractice | 0.16 | 0.579 |
(1.07 × 1 + 0.41 × 1.137 + 0.16 × 0.579) × $33.4009 = $54.40
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.
31231 billing questions
Should modifier 50 or RT/LT be added when both sides of the nose are scoped?
No. Report one unit for a bilateral examination without modifier 50 or RT/LT; the code is already priced as bilateral.
Can this code be billed with a surgical sinus endoscopy on the same side?
Do not separately report the diagnostic inspection of the same site during a surgical nasal or sinus endoscopy. Report the applicable surgical code when biopsy, polyp removal, or ethmoidectomy is performed.
When should 31233 or 31235 be reported instead?
Use 31233 for diagnostic maxillary sinusoscopy and 31235 for diagnostic sphenoid sinusoscopy. Inspection of the nasal cavity and sinus openings without entering either sinus remains 31231.
Can an office visit be billed on the same day as the endoscopy?
Yes, if the E/M service is significant and separately identifiable from the routine assessment and same-day care included with the endoscopy. Append modifier 25 to the E/M code.
Does passing a flexible laryngoscope through the nose support a separate nasal endoscopy?
No. Transnasal passage to examine the larynx does not by itself establish a separate diagnostic nasal examination. Report 31231 only when a medically necessary nasal cavity examination is separately performed and documented.
What documentation supports the procedure?
Record the indication, sides examined, structures viewed, and endoscopic findings. Document the scope type and any anesthetic or decongestant used; a note stating only “nasal exam” does not establish the endoscopic examination.
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.
3,5213120F,,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
3,52731237,,Nsl/sins ndsc surg bx polypc,A,,2.54,5.07,,1.23,,0.37,7.98,4.14,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014