No office rate
31610 creates a tracheostomy with a skin flap; 31611 creates a tracheoesophageal passage and inserts a voice prosthesis.
On this page
CMS RVU26D · Effective 2026-10-01
31611 Voice fistula Medicare reimbursement rates in Rhode Island
Creates a tracheoesophageal passage and places a voice prosthesis, typically for speech restoration after total laryngectomy. Compare 31611 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 31611 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
No supported rate
Facility setting
$500.36
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.
Airway surgery
About 31611: Tracheoesophageal voice fistula construction
Creates a tracheoesophageal passage and places a voice prosthesis, typically for speech restoration after total laryngectomy.
An otolaryngologist or head and neck surgeon creates a controlled opening between the trachea and esophagus and inserts a voice prosthesis. The passage lets exhaled air reach the pharyngoesophageal segment to support speech after removal of the larynx. The procedure may be done during the laryngectomy as a primary puncture or later as a secondary puncture in a patient with an established laryngectomy stoma.
Report the service when the operative work includes construction of the fistula and placement of the prosthesis; documentation should identify the procedure, the prosthesis, and whether the puncture is primary or secondary. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. In a same-session multiple-procedure claim, the highest-valued procedure is paid in full and other procedures at 50%. Modifier 50 is inappropriate for this service. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 31611
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.85 · 40%
- Practice expense (office) RVU7.98 · 54%
- Malpractice RVU0.87 · 6%
551
Medicare services in 2024 · #3468 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.
31611 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
31613 revises a tracheostoma using a simple approach. It does not describe construction of a tracheoesophageal voice passage with prosthesis placement.
No office rate
31614 is for complex tracheostoma revision, rather than creating a tracheoesophageal fistula and placing a voice prosthesis.
$176.71
31615 describes endoscopic examination through an established tracheostomy. It is an airway examination, not voice-fistula construction.
Compare 31611 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
Unavailable
Facility
$500.36
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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 31611 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
3,626
- Code
- 31611
- Physician work
- 5.85
- Practice expense
- 7.98
- Malpractice
- 0.87
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.85 | × 1.019 | 5.9611 |
| Practice expense | 7.98 | × 1.033 | 8.2433 |
| Malpractice | 0.87 | × 0.892 | 0.7760 |
| Total RVUs | 14.9805 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$500.36
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.85 | 1.019 |
| Practice expense | 7.98 | 1.033 |
| Malpractice | 0.87 | 0.892 |
(5.85 × 1.019 + 7.98 × 1.033 + 0.87 × 0.892) × $33.4009 = $500.36
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.
31611 billing questions
How is this different from a tracheostomy?
This procedure creates a passage between the trachea and esophagus and places a voice prosthesis for speech after laryngectomy. A tracheostomy creates an airway opening through the neck.
Can it be performed during a total laryngectomy?
Yes. A primary tracheoesophageal puncture may be created during total laryngectomy; a secondary puncture is performed later through the established laryngectomy stoma.
Should modifier 50 be used for a bilateral procedure?
No. The anatomy and service described do not support a bilateral adjustment or modifier 50.
What does the 90-day global period include?
It includes the day-before preoperative visit and 90 days of related postoperative care.
How does the multiple-procedure reduction affect this code?
When performed in the same session with other procedures, the highest-valued procedure is paid in full and the other procedures at 50%. The reduction depends on the relative values of the procedures in that session.
What documentation supports reporting the service?
The operative report should describe creation of the tracheoesophageal passage and insertion of the voice prosthesis, and indicate whether the puncture was primary or secondary.
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.
3,62331605,,Emer tracheostomy cthyr mem,A,,6.29,1.40,NA,1.40,,1.37,9.06,9.06,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,6243160F,,Doc fe+ stores b/4 epo thx,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
3,62531610,,Tracheostomy fenest skin flp,A,,11.70,12.15,NA,12.15,,1.92,25.77,25.77,0,090,0.10,0.76,0.14,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,62631611,,Constj trachesophgl fstl,A,,5.85,7.98,NA,7.98,,0.87,14.70,14.70,0,090,0.10,0.76,0.14,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,62731612,,Perq trchl pnxr ttrach aspir,A,,0.89,1.81,,0.22,,0.14,2.84,1.25,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,62831613,,Tracheostoma revj simple,A,,4.59,6.52,NA,6.52,,0.75,11.86,11.86,0,090,0.10,0.76,0.14,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,62931614,,Tracheostoma revj complex,A,,8.41,9.59,NA,9.59,,1.23,19.23,19.23,0,090,0.10,0.76,0.14,2,0,1,0,0,9,,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