No office rate
Use 31293 when both medial and inferior orbital walls are decompressed. Code 31292 describes medial-wall decompression alone.
On this page
CMS RVU26D · Effective 2026-10-01
31293 Orbital decompression Medicare reimbursement rates in Kentucky
Reports endoscopic removal of bone from the medial and inferior orbital walls to expand orbital space, commonly for thyroid eye disease with proptosis. Compare 31293 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 31293 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
No supported rate
Facility setting
$886.03
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.
Nasal and sinus endoscopy
About 31293: Endoscopic medial and inferior orbital decompression
Reports endoscopic removal of bone from the medial and inferior orbital walls to expand orbital space, commonly for thyroid eye disease with proptosis.
An otolaryngologist typically reaches the orbit through the nasal cavity and removes bone from both the medial and inferior orbital walls, creating additional space for the orbital contents. A common clinical setting is thyroid eye disease with proptosis or orbital pressure. The procedure may be coordinated with an ophthalmologist, including an oculoplastic surgeon, but the operative report should identify the decompression performed and the treated side or sides.
Select this service when the documented endoscopic decompression includes both orbital walls; medial-wall decompression alone is a different level of service. The operative report should support the indication, approach, walls decompressed, and laterality. CMS assigns a 10-day global period, so related postoperative visits during that period are included. When related endoscopies are performed together, endoscopy family pricing applies. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 31293
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are 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 RVU17.03 · 62%
- Practice expense (office) RVU8.12 · 29%
- Malpractice RVU2.49 · 9%
34
Medicare services in 2024 · #5579 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.
31293 compared with similar codes
Office rates for Kentucky, from the same CMS release.
No office rate
This service expands orbital space by decompression of the medial and inferior walls; 31294 is directed at optic nerve decompression.
No office rate
Code 31276 reports endoscopic frontal sinus surgery, including removal of tissue when indicated; it does not describe orbital wall decompression.
Compare 31293 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
Unavailable
Facility
$886.03
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 31293 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
3,548
- Code
- 31293
- Physician work
- 17.03
- Practice expense
- 8.12
- Malpractice
- 2.49
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 17.03 | × 1.000 | 17.0300 |
| Practice expense | 8.12 | × 0.889 | 7.2187 |
| Malpractice | 2.49 | × 0.915 | 2.2784 |
| Total RVUs | 26.5270 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Kentucky$886.03
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 17.03 | 1 |
| Practice expense | 8.12 | 0.889 |
| Malpractice | 2.49 | 0.915 |
(17.03 × 1 + 8.12 × 0.889 + 2.49 × 0.915) × $33.4009 = $886.03
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.
31293 billing questions
How does this differ from code 31292?
This code describes decompression of both the medial and inferior orbital walls. Code 31292 is for medial-wall decompression.
What documentation supports reporting this code?
The operative report should describe the endoscopic approach, the orbital walls decompressed, and the treated side or sides, along with the clinical indication.
How is bilateral decompression reported?
Report bilateral treatment with modifier 50. CMS pays the bilateral procedure at 150%.
Are postoperative visits separately reported during the global period?
Related postoperative visits for 10 days are included in the minor-procedure global period.
What happens when related endoscopies are performed at the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. Document each distinct procedure performed.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment is allowed only with 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.
3,54531290,,Nasal/sinus endoscopy surg,A,,18.14,8.73,NA,8.73,,2.84,29.71,29.71,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54631291,,Nasal/sinus endoscopy surg,A,,19.07,9.50,NA,9.50,,3.67,32.24,32.24,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54731292,,Nsl/sins ndsc med/inf dcmprn,A,,15.50,7.80,NA,7.80,,2.28,25.58,25.58,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54831293,,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
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