$1,652.71
31296 is the frontal sinus balloon-dilation service. Choose 31295 when the treated ostium is maxillary.
On this page
CMS RVU26D · Effective 2026-10-01
31295 Sinus dilation Medicare reimbursement rates in Rhode Island
Endoscopic balloon dilation of a maxillary sinus ostium is reported when an ENT surgeon enlarges its natural drainage opening without conventional tissue removal. Compare 31295 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 31295 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
$1626.52
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
Facility setting
$136.33
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.
Nasal/sinus surgery
About 31295: Endoscopic maxillary sinus balloon dilation
Endoscopic balloon dilation of a maxillary sinus ostium is reported when an ENT surgeon enlarges its natural drainage opening without conventional tissue removal.
An otolaryngologist uses a nasal endoscope to guide a balloon into the natural opening of a maxillary sinus and enlarge that drainage pathway. This approach may be used for obstructed maxillary sinus drainage, including in patients with chronic or recurrent sinusitis. The procedure is distinct from creating a wider opening by removing tissue or bone during conventional endoscopic sinus surgery.
Report the code for the maxillary sinus ostium dilation performed, and document the treated side, the sinus, the technique, and the clinical findings supporting the intervention. CMS treats the service as a minor procedure with a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When related endoscopies are performed together, endoscopy family pricing applies. CMS allows payment for an assistant at surgery; co-surgeons and team surgery are not permitted.
CMS billing rules for 31295
- 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU2.63 · 6%
- Practice expense (office) RVU44.21 · 94%
- Malpractice RVU0.39 · 1%
14.5K
Medicare services in 2024 · #1272 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.
31295 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
$1,613.32
31297 applies to balloon dilation of the sphenoid sinus ostium, not the maxillary ostium.
No office rate
31256 represents conventional endoscopic maxillary sinus exploration and opening. Use 31295 when the documented intervention is balloon dilation of the ostium.
No office rate
31267 includes removal of tissue from the maxillary sinus. The defining intervention for 31295 is balloon dilation of the ostium.
Compare 31295 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
$1626.52
Facility
$136.33
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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 31295 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
3,550
- Code
- 31295
- Physician work
- 2.63
- Practice expense
- 44.21
- Malpractice
- 0.39
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.63 | × 1.019 | 2.6800 |
| Practice expense | 44.21 | × 1.033 | 45.6689 |
| Malpractice | 0.39 | × 0.892 | 0.3479 |
| Total RVUs | 48.6968 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Rhode Island$1626.52
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.63 | 1.019 |
| Practice expense | 44.21 | 1.033 |
| Malpractice | 0.39 | 0.892 |
(2.63 × 1.019 + 44.21 × 1.033 + 0.39 × 0.892) × $33.4009 = $1626.52
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.63 | 1.019 |
| Practice expense | 1.02 | 1.033 |
| Malpractice | 0.39 | 0.892 |
(2.63 × 1.019 + 1.02 × 1.033 + 0.39 × 0.892) × $33.4009 = $136.33
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.
31295 billing questions
How does this differ from 31256?
31295 describes balloon dilation of the maxillary sinus opening. Code 31256 is used for a conventional endoscopic maxillary sinus exploration and opening rather than balloon dilation.
When would 31267 be a better fit?
Use 31267 when the maxillary sinus procedure includes removal of tissue. Balloon dilation of the ostium without that tissue removal is the distinguishing service for 31295.
How is bilateral treatment reported?
CMS identifies this as a bilateral procedure: report modifier 50 for bilateral treatment. CMS pays the bilateral service at 150%.
What happens when another sinus endoscopy is performed during the same session?
CMS endoscopy family pricing applies when related endoscopies are performed together. The operative report should identify each sinus procedure performed.
Is same-day postoperative care separately included in the global period?
No. The 0-day global period includes same-day preoperative and postoperative care.
Can an assistant surgeon be reported?
CMS may pay for an assistant at surgery. Co-surgeons and team surgery are not permitted for this service under the supplied CMS rules.
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.
3,54731292,,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
3,55231297,,Nsl/sins ndsc surg sphn sins,A,,2.38,44.10,,0.96,,0.36,46.84,3.70,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,55331298,,Nsl/sins ndsc surg frnt&sphn,A,,4.39,83.78,,1.45,,0.62,88.79,6.46,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
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