$176.12
31231 describes diagnostic nasal endoscopy without sphenoid sinusoscopy. Report 31235 when the documented examination specifically reaches the sphenoid sinus.
On this page
CMS RVU26D · Effective 2026-10-01
31235 Sinus endoscopy Medicare reimbursement rates in Kansas
ENT clinicians report diagnostic sphenoid sinus endoscopy to inspect the sphenoid sinus through the nose when evaluating suspected or known sinus disease. Compare 31235 office and facility rates across CMS payment localities in Kansas.
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 31235 in Kansas?
Kansas 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
$283.80
1 of 1 localities have a supported rate.
Payment area: Kansas
One mapped payment locality.
Facility setting
$128.00
1 of 1 localities have a supported rate.
Payment area: Kansas
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 endoscopy
About 31235: Diagnostic sphenoid sinus endoscopy
ENT clinicians report diagnostic sphenoid sinus endoscopy to inspect the sphenoid sinus through the nose when evaluating suspected or known sinus disease.
An otolaryngologist passes an endoscope through the nasal passage to examine the sphenoid sinus. The diagnostic view can help assess suspected sphenoid sinus inflammation, a lesion, or other findings identified during evaluation of sinus symptoms or imaging. The service is performed in settings such as an ENT office or operating room when the purpose is diagnostic visualization rather than sphenoid sinus surgery.
Report the code when documentation supports examination of the sphenoid sinus, not merely a general nasal examination or visualization of another sinus. If the same session includes related nasal or sinus endoscopies, CMS endoscopy-family pricing applies. The code has a 0-day global period, so same-day preoperative and postoperative care is included. Modifier 50 identifies bilateral performance and CMS pays it at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 31235
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.57 · 28%
- Practice expense (office) RVU6.35 · 68%
- Malpractice RVU0.37 · 4%
385
Medicare services in 2024 · #3768 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.
31235 compared with similar codes
Office rates for Kansas, from the same CMS release.
$249.21
31233 is diagnostic endoscopy of the maxillary sinus; 31235 is selected for diagnostic examination of the sphenoid sinus.
No office rate
31287 describes surgical sphenoidotomy, not diagnostic visualization alone. Choose it when the operative work includes sphenoid surgery.
No office rate
31288 applies when sphenoid surgery includes tissue removal. Diagnostic sphenoid sinusoscopy without that surgical work is distinguished by 31235.
Compare 31235 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
Kansas →
Office / nonfacility
$283.80
Facility
$128.00
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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 31235 in Kansas.
PPRRVU2026_Oct_nonQPP.csv
3,526
- Code
- 31235
- Physician work
- 2.57
- Practice expense
- 6.35
- Malpractice
- 0.37
GPCI2026.csv
54
- Locality
- Kansas
- Physician work
- 1.000
- Practice expense
- 0.904
- Malpractice
- 0.504
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.57 | × 1.000 | 2.5700 |
| Practice expense | 6.35 | × 0.904 | 5.7404 |
| Malpractice | 0.37 | × 0.504 | 0.1865 |
| Total RVUs | 8.4969 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kansas$283.80
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.57 | 1 |
| Practice expense | 6.35 | 0.904 |
| Malpractice | 0.37 | 0.504 |
(2.57 × 1 + 6.35 × 0.904 + 0.37 × 0.504) × $33.4009 = $283.80
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.57 | 1 |
| Practice expense | 1.19 | 0.904 |
| Malpractice | 0.37 | 0.504 |
(2.57 × 1 + 1.19 × 0.904 + 0.37 × 0.504) × $33.4009 = $128.00
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.
31235 billing questions
How does this differ from diagnostic nasal endoscopy, 31231?
31235 includes diagnostic examination of the sphenoid sinus. Use 31231 for a diagnostic nasal examination that does not include sphenoid sinusoscopy.
How does this differ from diagnostic maxillary sinus endoscopy, 31233?
The distinction is the sinus examined: 31235 documents sphenoid sinusoscopy, while 31233 addresses maxillary sinusoscopy.
Can diagnostic sphenoid endoscopy be separately reported with sphenoid surgery?
When the same session proceeds to sphenoid surgery, compare the documented operative service with the surgical code, such as 31287 or 31288. Do not assume the diagnostic examination is separately reportable.
What modifier identifies bilateral performance?
Use modifier 50 for bilateral performance; CMS pays this procedure at 150% when reported bilaterally.
What documentation supports reporting 31235?
Document that the endoscope was used to examine the sphenoid sinus and record the diagnostic findings. A note describing only general nasal inspection does not establish sphenoid sinusoscopy.
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.
3,52331230,,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
3,52831238,,Nsl/sins ndsc srg nsl hemrrg,A,,2.67,4.73,,1.26,,0.39,7.79,4.32,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52931239,,Nsl/sinus endoscopy surg dcr,A,,8.81,5.91,NA,5.91,,0.99,15.71,15.71,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958