$581.78
30600 closes a communication between the oral and nasal cavities; 30580 is for a nasolabial fistula.
On this page
CMS RVU26D · Effective 2026-10-01
30600 Fistula repair Medicare reimbursement rates in Kentucky
Repair an abnormal opening between the mouth and nasal cavity, commonly after cleft palate surgery, trauma, or tissue removal. Compare 30600 office and facility rates across CMS payment localities in Kentucky.
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 30600 in Kentucky?
Kentucky 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
$561.96
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$365.69
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 surgery
About 30600: Oronasal fistula closure
Repair an abnormal opening between the mouth and nasal cavity, commonly after cleft palate surgery, trauma, or tissue removal.
This operation closes an abnormal passage connecting the oral and nasal cavities. It may be needed for a persistent opening after cleft palate repair or after trauma or removal of tissue. The surgeon identifies the communication and closes it, often using adjacent tissue. Otolaryngologists, plastic surgeons, and oral and maxillofacial surgeons may perform the repair in a hospital or surgical facility, or in an appropriately equipped office setting.
Report 30600 when the documented defect is an oronasal fistula and the service closes that communication. The operative note should identify the oral and nasal sides of the opening and describe the repair. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When other procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 30600
- 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 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 RVU6.01 · 33%
- Practice expense (office) RVU11.28 · 62%
- Malpractice RVU0.86 · 5%
119
Medicare services in 2024 · #4745 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.
30600 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
30630 addresses a nasal septal defect. Choose 30600 when the defect is an oronasal fistula.
No office rate
30620 describes intranasal reconstruction; 30600 specifically closes a passage between the mouth and nasal cavity.
Compare 30600 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
Kentucky →
Office / nonfacility
$561.96
Facility
$365.69
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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 30600 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
3,456
- Code
- 30600
- Physician work
- 6.01
- Practice expense
- 11.28
- Malpractice
- 0.86
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 6.01 | × 1.000 | 6.0100 |
| Practice expense | 11.28 | × 0.889 | 10.0279 |
| Malpractice | 0.86 | × 0.915 | 0.7869 |
| Total RVUs | 16.8248 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$561.96
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.01 | 1 |
| Practice expense | 11.28 | 0.889 |
| Malpractice | 0.86 | 0.915 |
(6.01 × 1 + 11.28 × 0.889 + 0.86 × 0.915) × $33.4009 = $561.96
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 6.01 | 1 |
| Practice expense | 4.67 | 0.889 |
| Malpractice | 0.86 | 0.915 |
(6.01 × 1 + 4.67 × 0.889 + 0.86 × 0.915) × $33.4009 = $365.69
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.
30600 billing questions
How is an oronasal fistula different from a nasolabial fistula?
30600 is for a communication between the mouth and nasal cavity. Use 30580 when the documented defect is a nasolabial fistula.
What documentation supports reporting 30600?
Document the opening's location and its communication between the oral and nasal cavities, along with the closure performed.
Can modifier 50 be used for fistulas on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the global period affect postoperative visits?
The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery.
What if another procedure is performed during the same session?
CMS applies the standard multiple procedure reduction: the highest-valued procedure is paid in full, and other procedures are reduced. Assistant-at-surgery payment requires documentation of medical necessity; 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.
3,45330560,,Lysis intranasal synechia,A,,1.28,7.97,,2.71,,0.19,9.44,4.18,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,4543056F,,Lvef greater than 35%,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
3,45530580,,Repair upper jaw fistula,A,,6.71,11.16,,5.00,,0.86,18.73,12.57,0,090,0.10,0.76,0.14,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,45630600,,Repair mouth/nose fistula,A,,6.01,11.28,,4.67,,0.86,18.15,11.54,0,090,0.10,0.76,0.14,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,4573060F,,Pos microalbuminuria rev,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
3,4583061F,,Neg microalbuminuria rev,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
3,45930620,,Intranasal reconstruction,A,,6.01,11.60,NA,11.60,,0.88,18.49,18.49,0,090,0.10,0.76,0.14,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
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
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631