No office rate
Use 31292 for endoscopic medial orbital wall decompression. Code 31294 identifies decompression directed at the optic nerve.
On this page
CMS RVU26D · Effective 2026-10-01
31294 Optic nerve decompression Medicare reimbursement rates in Utah
Reports endoscopic decompression of the optic nerve through the nasal and sinus passages for selected patients with compressive optic neuropathy. Compare 31294 office and facility rates across CMS payment localities in Utah.
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 31294 in Utah?
Utah 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
$1024.61
1 of 1 localities have a supported rate.
Payment area: Utah
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 and sinus surgery
About 31294: Endoscopic optic nerve decompression
Reports endoscopic decompression of the optic nerve through the nasal and sinus passages for selected patients with compressive optic neuropathy.
An otolaryngologist or rhinologic surgeon uses an endoscope passed through the nasal cavity to reach and decompress the optic nerve, typically by removing bone over the nerve’s canal. The procedure is performed in an operating room for selected patients with compressive optic neuropathy; ophthalmology or other specialists may participate in treatment planning. The operative record should identify the affected side, the optic nerve as the decompression target, the endoscopic route, and the work performed.
Report the code when the documented service is endoscopic optic nerve decompression, not sinus drainage alone or orbital wall decompression. Related endoscopies performed together are subject to CMS endoscopy family pricing. The procedure has a 10-day global period, which includes related postoperative visits during that period. For bilateral surgery, modifier 50 is paid at 150%. An assistant at surgery is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 31294
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days are 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU19.80 · 63%
- Practice expense (office) RVU8.80 · 28%
- Malpractice RVU2.90 · 9%
32
Medicare services in 2024 · #5615 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.
31294 compared with similar codes
Office rates for Utah, from the same CMS release.
No office rate
Use 31293 for endoscopic decompression of the medial and inferior orbital walls; 31294 is for optic nerve decompression.
No office rate
Code 31287 describes endoscopic sphenoid sinusotomy without tissue removal. It does not describe optic nerve decompression.
No office rate
Code 31288 describes endoscopic sphenoid sinusotomy with tissue removal. Report 31294 only when the optic nerve itself is decompressed.
Compare 31294 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
Utah →
Office / nonfacility
Unavailable
Facility
$1024.61
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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 31294 in Utah.
PPRRVU2026_Oct_nonQPP.csv
3,549
- Code
- 31294
- Physician work
- 19.80
- Practice expense
- 8.80
- Malpractice
- 2.90
GPCI2026.csv
104
- Locality
- Utah
- Physician work
- 1.000
- Practice expense
- 0.940
- Malpractice
- 0.898
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 19.80 | × 1.000 | 19.8000 |
| Practice expense | 8.80 | × 0.940 | 8.2720 |
| Malpractice | 2.90 | × 0.898 | 2.6042 |
| Total RVUs | 30.6762 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Utah$1024.61
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 19.8 | 1 |
| Practice expense | 8.8 | 0.94 |
| Malpractice | 2.9 | 0.898 |
(19.8 × 1 + 8.8 × 0.94 + 2.9 × 0.898) × $33.4009 = $1024.61
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.
31294 billing questions
How does this differ from codes 31292 and 31293?
Code 31294 is for decompression directed at the optic nerve. Codes 31292 and 31293 describe endoscopic orbital wall decompression, with the decompressed orbital walls distinguishing those services.
Is a sphenoidotomy by itself reported as 31294?
No. The documented service must include optic nerve decompression; opening the sphenoid sinus for drainage is a different service.
What documentation supports reporting this code?
Document the indication, side, optic nerve as the target, endoscopic nasal route, and the decompression performed. Identify any other endoscopic procedures done during the same operation.
How are related endoscopies handled when performed in the same operation?
CMS endoscopy family pricing applies when related endoscopies are performed together. The record should specify each procedure and its distinct target.
Can modifier 50 be used for bilateral decompression?
Yes. CMS pays the bilateral procedure reported with modifier 50 at 150%.
When is an assistant at surgery payable?
Only when documentation supports medical necessity. CMS does not permit co-surgeons or team surgery for this code.
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.
3,54631291,,Nasal/sinus endoscopy surg,A,,19.07,9.50,NA,9.50,,3.67,32.24,32.24,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,54731292,,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
10104412,TX,15,GALVESTON,1.008,0.993,0.828
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985