$442.98
Choose 31030 for intranasal maxillary sinus exploration; 31020 describes maxillary sinusotomy through the Caldwell-Luc approach.
On this page
CMS RVU26D · Effective 2026-10-01
31030 Sinus exploration Medicare reimbursement rates in Rhode Island
Intranasal exploration of the maxillary sinus is reported when an otolaryngologist surgically enters and examines that sinus rather than irrigating it. Compare 31030 office and facility rates across CMS payment localities in Rhode Island.
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 31030 in Rhode Island?
Rhode Island 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
$667.43
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$483.53
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 31030: Intranasal maxillary sinus exploration
Intranasal exploration of the maxillary sinus is reported when an otolaryngologist surgically enters and examines that sinus rather than irrigating it.
An otolaryngologist uses an intranasal surgical approach to enter and examine the maxillary sinus, such as when evaluating disease or a suspected abnormality within the sinus. This is an operative exploration, not simply office-based nasal examination or lavage. The operative note should identify the maxillary sinus treated, the intranasal approach, and the findings or purpose of the exploration.
Report this code for the documented intranasal exploration; use a different code when the service is irrigation, a Caldwell-Luc approach, or endoscopic antrostomy. The service has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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% reduction. For bilateral performance, modifier 50 is paid at 150%. Medicare does not pay an assistant at surgery for this code; co-surgeons and team surgery are not permitted.
CMS billing rules for 31030
- 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 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 RVU5.86 · 30%
- Practice expense (office) RVU12.89 · 66%
- Malpractice RVU0.78 · 4%
273
Medicare services in 2024 · #4065 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.
31030 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$192.95
31000 is maxillary sinus irrigation by lavage. It does not describe operative exploration of the sinus.
No office rate
31256 describes endoscopic maxillary antrostomy. Distinguish it from 31030 by the documented procedure and approach.
Compare 31030 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
Rhode Island →
Office / nonfacility
$667.43
Facility
$483.53
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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 31030 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
3,497
- Code
- 31030
- Physician work
- 5.86
- Practice expense
- 12.89
- Malpractice
- 0.78
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.86 | × 1.019 | 5.9713 |
| Practice expense | 12.89 | × 1.033 | 13.3154 |
| Malpractice | 0.78 | × 0.892 | 0.6958 |
| Total RVUs | 19.9825 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$667.43
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.86 | 1.019 |
| Practice expense | 12.89 | 1.033 |
| Malpractice | 0.78 | 0.892 |
(5.86 × 1.019 + 12.89 × 1.033 + 0.78 × 0.892) × $33.4009 = $667.43
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.86 | 1.019 |
| Practice expense | 7.56 | 1.033 |
| Malpractice | 0.78 | 0.892 |
(5.86 × 1.019 + 7.56 × 1.033 + 0.78 × 0.892) × $33.4009 = $483.53
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.
31030 billing questions
How is this different from 31020?
31030 describes intranasal exploration of the maxillary sinus. Code 31020 is for a maxillary sinusotomy using the Caldwell-Luc approach.
Can maxillary sinus irrigation be reported instead?
No. Code 31000 describes maxillary sinus irrigation; use 31030 when the documented service is surgical intranasal exploration rather than lavage.
What documentation supports 31030?
Document the maxillary sinus explored, the intranasal surgical approach, and the operative findings or reason for exploration.
What is included in the global period?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
How are bilateral and same-session procedures handled?
Bilateral performance with modifier 50 is paid at 150%. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others are paid at 50%.
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.
3,49431002,,Irrigation sphenoid sinus,A,,1.91,2.91,NA,2.91,,0.19,5.01,5.01,0,010,0.10,0.80,0.10,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,4953100F,,Image test ref carot diam,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
3,49631020,,Exploration maxillary sinus,A,,2.99,9.57,,6.43,,0.37,12.93,9.79,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,49731030,,Exploration maxillary sinus,A,,5.86,12.89,,7.56,,0.78,19.53,14.20,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,49831032,,Explore sinus remove polyps,A,,6.52,9.07,NA,9.07,,0.93,16.52,16.52,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,49931040,,Exploration behind upper jaw,A,,9.53,10.65,NA,10.65,,1.43,21.61,21.61,0,090,0.10,0.76,0.14,2,1,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,50031050,,Exploration sphenoid sinus,A,,5.24,8.26,NA,8.26,,0.78,14.28,14.28,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537