Billing code 69540: Aural polypMedicare rate & RVUs in Massachusetts
Reports surgical removal of an aural polyp, commonly encountered with chronic ear disease, rather than diagnostic sampling or treatment of another ear lesion.
Medicare pays $218.18–$242.79 for 69540 in the office in Massachusetts, from Rest Of Massachusetts to Metropolitan Boston. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 69540 covers
billing code 69540 represents surgical removal of an aural polyp, often tissue protruding into the ear canal in the setting of chronic middle-ear inflammation or infection. An otolaryngologist, frequently an otologist, removes the polyp under direct visualization in an office or facility setting. The code describes excision of the polyp, not simply examination or diagnostic sampling of an ear lesion.
Document the affected ear, the polyp and its site, the removal performed, and relevant underlying ear disease; distinguish excision from biopsy. Medicare assigns a 10-day global period, including related postoperative visits during that period. For bilateral procedures, modifier 50 is paid at 150%. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are paid at 50%. Assistant-at-surgery services are not paid under the statutory restriction; co-surgeons and team surgery are not permitted.
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.
Where 69540 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston | $242.79 | $135.51 |
| Rest Of Massachusetts | $218.18 | $123.57 |
How the 69540 rate is calculated
Each of 69540’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 69540
RVUs × geographic indexes × conversion factor
Work1.22
1.22 RVUs× 1.000 GPCI
Practice expense4.89
4.89 RVUs× 1.000 GPCI
Malpractice0.18
0.18 RVUs× 1.000 GPCI
Adjusted RVUs
6.2900
Conversion factor
$33.4009
Medicare rate
$210.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 69540
69540 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 69540
Aural polyp
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 69540
Aural polyp
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
69540 without 50 · national office
$210.09
Aural polyp
69540-50 · Bilateral: 150%
$315.14
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
69540 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 69105Ear canal biopsy
- 69105 describes biopsy of an external auditory canal lesion. Choose 69540 when the documented procedure is excision of an aural polyp, not diagnostic sampling.
- 69145Ear canal excision
- 69145 applies to excision of a soft-tissue lesion in the external auditory canal when it is not documented as an aural polyp.
- 69110Auricular excision
- 69110 concerns a lesion of the external ear. 69540 is for an aural polyp, not a lesion on the outer ear.
69540 billing questions
How is 69540 distinguished from a biopsy of an ear-canal lesion?
Use 69540 when the documented service is excision of an aural polyp. When tissue is sampled for diagnosis rather than excised as a polyp, consider 69105.
Is an aural polyp the same as any external auditory canal soft-tissue lesion?
No. 69540 identifies an aural polyp; 69145 is for excision of a documented external auditory canal soft-tissue lesion that is not characterized as an aural polyp.
How should bilateral excision be reported?
For excision performed on both sides, report modifier 50. CMS pays bilateral procedures at 150%.
What postoperative care is included?
Related postoperative visits during the 10-day global period are included in the procedure.
How does the multiple-procedure rule affect 69540?
When it is the highest-valued procedure in the same session, it is paid in full; other procedures are paid at 50%. If another procedure is highest-valued, 69540 is among the other procedures.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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