No office rate
Choose 31590 when the operation connects a donor nerve to the recurrent laryngeal nerve. Choose 31591 for laryngeal framework medialization.
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CMS RVU26D · Effective 2026-10-01
31590 Laryngeal reinnervation Medicare reimbursement rates in Iowa
Open laryngeal nerve reinnervation connects a donor ansa cervicalis motor branch to the recurrent laryngeal nerve to treat selected vocal fold paralysis. Compare 31590 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 31590 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
$809.48
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.
Laryngeal surgery
About 31590: Laryngeal nerve reinnervation
Open laryngeal nerve reinnervation connects a donor ansa cervicalis motor branch to the recurrent laryngeal nerve to treat selected vocal fold paralysis.
An otolaryngologist or head and neck surgeon performs this open neck procedure to restore neural input to a paralyzed vocal fold. The usual technique connects a motor branch of the ansa cervicalis to the distal recurrent laryngeal nerve. It is used for selected cases of vocal fold paralysis, including paralysis after thyroid or other neck surgery, when the clinical plan is to reinnervate the larynx rather than simply medialize the fold.
Report the code for the reinnervation procedure itself, not for laryngoscopic injection or framework medialization performed as a different treatment. The operative report should identify the donor and recipient nerves, the nerve connection performed, and the indication. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 31590
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are 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
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.65 · 29%
- Practice expense (office) RVU17.64 · 67%
- Malpractice RVU1.12 · 4%
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.
31590 compared with similar codes
Office rates for Iowa, from the same CMS release.
$825.67
31574 reports laryngoscopic vocal fold injection for augmentation; 31590 reports open nerve reinnervation.
$315.39
31570 describes direct laryngoscopic therapeutic injection into the vocal fold, not an open nerve connection.
Compare 31590 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
$809.48
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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 31590 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
3,616
- Code
- 31590
- Physician work
- 7.65
- Practice expense
- 17.64
- Malpractice
- 1.12
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.65 | × 1.000 | 7.6500 |
| Practice expense | 17.64 | × 0.915 | 16.1406 |
| Malpractice | 1.12 | × 0.397 | 0.4446 |
| Total RVUs | 24.2352 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$809.48
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.65 | 1 |
| Practice expense | 17.64 | 0.915 |
| Malpractice | 1.12 | 0.397 |
(7.65 × 1 + 17.64 × 0.915 + 1.12 × 0.397) × $33.4009 = $809.48
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.
31590 billing questions
How is 31590 different from medialization laryngoplasty 31591?
31590 reinnervates the larynx by connecting a donor motor nerve to the recurrent laryngeal nerve. Code 31591 describes framework surgery to medialize the vocal fold rather than nerve transfer.
When might 31574 be reported instead?
31574 is for laryngoscopic vocal fold injection to improve glottic closure. It is a different treatment approach from open nerve reinnervation and should be selected when injection, not nerve connection, is performed.
Should modifier 50 be appended for bilateral work?
No. CMS identifies modifier 50 as inappropriate for 31590 because the descriptor or anatomy does not support a bilateral adjustment.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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.
3,61331580,,Laryngoplasty laryngeal web,A,,14.24,18.58,NA,18.58,,2.08,34.90,34.90,0,090,0.10,0.76,0.14,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,61431584,,Laryngoplasty fx rdctj fixj,A,,17.14,18.28,NA,18.28,,2.50,37.92,37.92,0,090,0.10,0.76,0.14,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,61531587,,Laryngoplasty cricoid split,A,,14.89,15.59,NA,15.59,,2.17,32.65,32.65,0,090,0.10,0.76,0.14,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,61631590,,Reinnervate larynx,A,,7.65,17.64,NA,17.64,,1.12,26.41,26.41,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,61731591,,Laryngoplasty medialization,A,,13.22,14.78,NA,14.78,,1.93,29.93,29.93,0,090,0.10,0.76,0.14,2,1,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,61831592,,Cricotracheal resection,A,,24.38,17.90,NA,17.90,,3.56,45.84,45.84,0,090,0.10,0.76,0.14,2,0,0,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,61931599,,Unlisted procedure larynx,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