No office rate
31254 is for partial ethmoidectomy, generally anterior. 31255 is for total ethmoidectomy.
On this page
CMS RVU26D · Effective 2026-10-01
31254 Ethmoidectomy Medicare reimbursement rates in Missouri
Reports endoscopic removal of part of the anterior ethmoid air cells during surgery for ethmoid sinus disease, rather than complete ethmoidectomy. Compare 31254 office and facility rates across CMS payment localities in Missouri.
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 31254 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
$397.73–$423.27
3 of 3 localities have a supported rate.
Facility setting
$198.78–$203.55
3 of 3 localities have a supported rate.
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.
Where 31254 pays more and less in Missouri
3 payment localities
$397.73 to $423.27
Nasal and sinus surgery
About 31254: Endoscopic partial ethmoidectomy
Reports endoscopic removal of part of the anterior ethmoid air cells during surgery for ethmoid sinus disease, rather than complete ethmoidectomy.
An otolaryngologist uses a nasal endoscope and surgical instruments to remove part of the ethmoid air cells, typically the anterior portion, to treat disease such as chronic inflammation or obstructed drainage. The procedure is commonly performed in a hospital outpatient department or ambulatory surgery center. The extent is partial: complete ethmoid cell removal belongs to a different code. The operative report should identify the treated side, the ethmoid work performed, and the extent of tissue or partitions removed.
Report this code when the surgeon performs partial endoscopic ethmoidectomy, not for diagnostic nasal inspection alone. When related nasal or sinus endoscopies are performed together, CMS endoscopy-family pricing applies. For bilateral surgery, modifier 50 is paid at 150%. The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 31254
- 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU4.16 · 32%
- Practice expense (office) RVU8.31 · 64%
- Malpractice RVU0.60 · 5%
11.1K
Medicare services in 2024 · #1420 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.
31254 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
31253 describes total ethmoidectomy combined with frontal sinus surgery; 31254 is partial ethmoidectomy without that combined service.
$172.23–$186.09
31231 is diagnostic nasal endoscopy. It does not represent surgical removal of ethmoid cells.
No office rate
31256 reports endoscopic maxillary sinus exploration, not ethmoidectomy. Select based on the sinus actually treated.
Compare 31254 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
$419.16
Facility
$202.44
Metropolitan St. Louis →
Office / nonfacility
$423.27
Facility
$203.55
Rest Of Missouri →
Office / nonfacility
$397.73
Facility
$198.78
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31254 billing questions
How does this differ from 31255?
31254 describes partial ethmoidectomy, generally involving the anterior ethmoid cells. Use 31255 when the surgeon performs total ethmoidectomy.
Can this be reported with maxillary or frontal sinus surgery?
A surgeon may perform separately indicated work in other sinuses during the same operation. CMS endoscopy-family pricing applies when related endoscopies are performed together.
How is bilateral surgery reported?
Report bilateral surgery with modifier 50; CMS pays the bilateral procedure at 150%.
What documentation supports the partial ethmoidectomy?
The operative report should describe the endoscopic ethmoid work, identify the side, and make clear that the removal was partial rather than total.
Can an assistant surgeon or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. 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.
3,53231242,,Nsl/sinus ndsc rf abltj pnn,A,,2.63,68.70,,1.02,,0.39,71.72,4.04,0,000,0.00,0.00,0.00,3,2,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53331243,,Nsl/sinus ndsc cryoabltj pnn,A,,2.63,66.62,,1.02,,0.39,69.64,4.04,0,000,0.00,0.00,0.00,3,2,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53431253,,Nsl/sins ndsc total,A,,8.78,2.51,NA,2.51,,1.29,12.58,12.58,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53531254,,Nsl/sins ndsc w/prtl ethmdct,A,,4.16,8.31,,1.40,,0.60,13.07,6.16,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53631255,,Nsl/sins ndsc w/tot ethmdct,A,,5.61,1.75,NA,1.75,,0.82,8.18,8.18,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53731256,,Exploration maxillary sinus,A,,3.03,1.11,NA,1.11,,0.43,4.57,4.57,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53831257,,Nsl/sins ndsc tot w/sphendt,A,,7.80,2.29,NA,2.29,,1.14,11.23,11.23,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00