No office rate
Choose 31256 when the maxillary antrostomy is performed without removing tissue from within the sinus. Choose 31267 when sinus tissue is removed.
On this page
CMS RVU26D · Effective 2026-10-01
31256 Maxillary antrostomy Medicare reimbursement rates in Iowa
Report this procedure for endoscopic creation or enlargement of a maxillary sinus opening for drainage, without removing tissue from the sinus. Compare 31256 office and facility rates across CMS payment localities in Iowa.
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 31256 in Iowa?
Iowa 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
$140.83
1 of 1 localities have a supported rate.
Payment area: Iowa
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 endoscopy
About 31256: Endoscopic maxillary antrostomy without tissue removal
Report this procedure for endoscopic creation or enlargement of a maxillary sinus opening for drainage, without removing tissue from the sinus.
An otolaryngologist typically performs this endoscopic procedure through the nasal passage to create or enlarge an opening into a maxillary sinus, improving access and drainage. It is used in surgical treatment of conditions such as chronic maxillary sinusitis when an operative antrostomy is performed. The code describes the sinus opening, not removal of tissue from within the maxillary sinus.
Select this code when the operative report supports a surgical maxillary antrostomy without maxillary sinus tissue removal; use the tissue-removal sibling when tissue is removed from the sinus. Document the side, the work performed, and whether sinus tissue was removed. 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 work, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 31256
- 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 RVU3.03 · 66%
- Practice expense (office) RVU1.11 · 24%
- Malpractice RVU0.43 · 9%
11.5K
Medicare services in 2024 · #1403 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.
31256 compared with similar codes
Office rates for Iowa, from the same CMS release.
$250.24
31233 is diagnostic maxillary sinus endoscopy. This code describes an operative antrostomy, not inspection alone.
$177.22
31231 describes diagnostic nasal endoscopy. It does not represent surgical opening of the maxillary sinus.
$400.87
31254 describes partial ethmoidectomy, an operation on the ethmoid sinus. This code describes a maxillary sinus antrostomy.
Compare 31256 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
Iowa →
Office / nonfacility
Unavailable
Facility
$140.83
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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 31256 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
3,537
- Code
- 31256
- Physician work
- 3.03
- Practice expense
- 1.11
- Malpractice
- 0.43
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.03 | × 1.000 | 3.0300 |
| Practice expense | 1.11 | × 0.915 | 1.0157 |
| Malpractice | 0.43 | × 0.397 | 0.1707 |
| Total RVUs | 4.2164 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$140.83
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.03 | 1 |
| Practice expense | 1.11 | 0.915 |
| Malpractice | 0.43 | 0.397 |
(3.03 × 1 + 1.11 × 0.915 + 0.43 × 0.397) × $33.4009 = $140.83
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.
31256 billing questions
How does this differ from 31267?
This code describes a maxillary antrostomy without removal of tissue from the maxillary sinus. Report 31267 when tissue is removed from within the sinus.
Can diagnostic nasal endoscopy be reported instead?
No, when the service includes a surgical maxillary antrostomy. Diagnostic endoscopy codes describe examination without this operative opening.
What should the operative report document?
Document the side, the maxillary sinus opening performed, and whether tissue was removed from within the sinus. These details support selection between this code and 31267.
How is bilateral work reported?
Use modifier 50 for bilateral performance; CMS pays the bilateral procedure at 150%.
Can an assistant, co-surgeon, or surgical team be paid?
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.
3,53431253,,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
3,53931259,,Nsl/sins ndsc sphn tiss rmvl,A,,8.27,2.40,NA,2.40,,1.22,11.89,11.89,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54031267,,Endoscopy maxillary sinus,A,,4.56,1.49,NA,1.49,,0.66,6.71,6.71,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136