$1,444.15
Choose 31295 for dilation of the maxillary sinus opening; 31296 is specific to the frontal sinus opening.
On this page
CMS RVU26D · Effective 2026-10-01
31296 Sinus dilation Medicare reimbursement rates in Iowa
Report this service for endoscopic dilation of a frontal sinus opening, commonly using a balloon to improve drainage without removing sinus tissue. Compare 31296 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 31296 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
$1468.10
1 of 1 localities have a supported rate.
Payment area: Iowa
One mapped payment locality.
Facility setting
$140.50
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 31296: Endoscopic frontal sinus ostium dilation
Report this service for endoscopic dilation of a frontal sinus opening, commonly using a balloon to improve drainage without removing sinus tissue.
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.
CMS billing rules for 31296
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU3.02 · 6%
- Practice expense (office) RVU44.55 · 93%
- Malpractice RVU0.43 · 1%
5K
Medicare services in 2024 · #1873 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.
31296 compared with similar codes
Office rates for Iowa, from the same CMS release.
$1,432.04
Choose 31297 for dilation of the sphenoid sinus opening; 31296 is specific to the frontal sinus opening.
$2,715.32
31298 describes dilation of both frontal and sphenoid sinus openings. Use 31296 when the documented dilation is limited to the frontal sinus.
No office rate
31276 describes frontal sinus exploration with tissue removal when performed. 31296 represents dilation of the frontal sinus opening, not tissue removal.
Compare 31296 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
$1468.10
Facility
$140.50
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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 31296 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
3,551
- Code
- 31296
- Physician work
- 3.02
- Practice expense
- 44.55
- 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 | 3.02 | × 1.000 | 3.0200 |
| Practice expense | 44.55 | × 0.915 | 40.7632 |
| Malpractice | 0.43 | × 0.397 | 0.1707 |
| Total RVUs | 43.9540 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$1468.10
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.02 | 1 |
| Practice expense | 44.55 | 0.915 |
| Malpractice | 0.43 | 0.397 |
(3.02 × 1 + 44.55 × 0.915 + 0.43 × 0.397) × $33.4009 = $1468.10
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.02 | 1 |
| Practice expense | 1.11 | 0.915 |
| Malpractice | 0.43 | 0.397 |
(3.02 × 1 + 1.11 × 0.915 + 0.43 × 0.397) × $33.4009 = $140.50
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.
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 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.
3,54831293,,Nsl/sins ndsc med&inf dcmprn,A,,17.03,8.12,NA,8.12,,2.49,27.64,27.64,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54931294,,Nsl/sins ndsc surg on dcmprn,A,,19.80,8.80,NA,8.80,,2.90,31.50,31.50,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55031295,,Nsl/sins ndsc surg max sins,A,,2.63,44.21,,1.02,,0.39,47.23,4.04,0,000,0.00,0.00,0.00,3,1,2,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55131296,,Nsl/sins ndsc surg frnt sins,A,,3.02,44.55,,1.11,,0.43,48.00,4.56,0,000,0.00,0.00,0.00,3,1,2,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55231297,,Nsl/sins ndsc surg sphn sins,A,,2.38,44.10,,0.96,,0.36,46.84,3.70,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55331298,,Nsl/sins ndsc surg frnt&sphn,A,,4.39,83.78,,1.45,,0.62,88.79,6.46,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55431299,,Unlisted px accessory sinus,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,YYY,0.00,0.00,0.00,2,0,0,1,1,9,,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