Billing code 31590: Laryngeal reinnervationMedicare rate & RVUs in Ohio
Open laryngeal nerve reinnervation connects a donor ansa cervicalis motor branch to the recurrent laryngeal nerve to treat selected vocal fold paralysis.
CMS doesn’t publish an office rate for 31590 in Ohio.
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 31590 covers
An otolaryngologist or head and neck surgeon performs this open neck procedure to restore neural input to a paralyzed vocal fold. The usual technique connects a motor branch of the ansa cervicalis to the distal recurrent laryngeal nerve. It is used for selected cases of vocal fold paralysis, including paralysis after thyroid or other neck surgery, when the clinical plan is to reinnervate the larynx rather than simply medialize the fold.
Report the code for the reinnervation procedure itself, not for laryngoscopic injection or framework medialization performed as a different treatment. The operative report should identify the donor and recipient nerves, the nerve connection performed, and the indication. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is 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.
31590 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $831.16 |
How the 31590 rate is calculated
Each of 31590’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 · 31590
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 7.65Practice expense 17.64Malpractice 1.12
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 31590
31590 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 31590
Laryngeal reinnervation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.76/0.14 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 31590
Laryngeal reinnervation
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
31590 without 51 · national facility
$882.12
Laryngeal reinnervation
31590-51 · Second procedure: 50%
$441.06
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
31590 compared with similar codes
Compare codes
31590 vs 31591 vs 31574 vs 31570: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 31591Laryngoplasty
- Choose 31590 when the operation connects a donor nerve to the recurrent laryngeal nerve. Choose 31591 for laryngeal framework medialization.
- 31574Vocal fold injection
- 31574 reports laryngoscopic vocal fold injection for augmentation; 31590 reports open nerve reinnervation.
- 31570Vocal fold injection
- 31570 describes direct laryngoscopic therapeutic injection into the vocal fold, not an open nerve connection.
31590 billing questions
How is 31590 different from medialization laryngoplasty 31591?
31590 reinnervates the larynx by connecting a donor motor nerve to the recurrent laryngeal nerve. Code 31591 describes framework surgery to medialize the vocal fold rather than nerve transfer.
When might 31574 be reported instead?
31574 is for laryngoscopic vocal fold injection to improve glottic closure. It is a different treatment approach from open nerve reinnervation and should be selected when injection, not nerve connection, is performed.
Should modifier 50 be appended for bilateral work?
No. CMS identifies modifier 50 as inappropriate for 31590 because the descriptor or anatomy does not support a bilateral adjustment.
What postoperative care is included in the global period?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is 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 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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