No office rate
Both are intranasal ethmoidectomies; 31200 is limited to the anterior ethmoid, while 31201 represents total ethmoid removal.
On this page
CMS RVU26D · Effective 2026-10-01
31200 Ethmoidectomy Medicare reimbursement rates in Vermont
Reports surgical removal of anterior ethmoid air cells through an intranasal approach, rather than endoscopic ethmoidectomy or a more extensive ethmoid removal. Compare 31200 office and facility rates across CMS payment localities in Vermont.
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 31200 in Vermont?
Vermont 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
$573.06
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Sinus surgery
About 31200: Anterior intranasal ethmoidectomy
Reports surgical removal of anterior ethmoid air cells through an intranasal approach, rather than endoscopic ethmoidectomy or a more extensive ethmoid removal.
An otolaryngologist removes diseased tissue and air cells from the anterior ethmoid sinus through the nasal passage. The operation may be performed for ethmoid sinus disease when surgical treatment is needed; the code identifies the anterior portion and intranasal approach. It is distinct from endoscopic ethmoidectomy codes and from removal of the entire ethmoid sinus.
Report this code when the operative record supports an anterior intranasal ethmoidectomy, documenting the approach, extent, and side treated. It has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care. For bilateral procedures, 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 at 50%. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 31200
- 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 RVU5.01 · 29%
- Practice expense (office) RVU12.05 · 69%
- Malpractice RVU0.43 · 2%
876
Medicare services in 2024 · #3064 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.
31200 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
31205 describes total ethmoid removal through an extranasal approach. Choose 31200 for the anterior intranasal operation.
$423.87
31254 is for partial ethmoidectomy performed endoscopically. The approach, not just the limited extent, distinguishes it from 31200.
No office rate
31255 reports total endoscopic ethmoidectomy; 31200 reports anterior ethmoid removal through an intranasal approach.
Compare 31200 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
Vermont →
Office / nonfacility
Unavailable
Facility
$573.06
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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 31200 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,518
- Code
- 31200
- Physician work
- 5.01
- Practice expense
- 12.05
- Malpractice
- 0.43
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.01 | × 1.000 | 5.0100 |
| Practice expense | 12.05 | × 0.990 | 11.9295 |
| Malpractice | 0.43 | × 0.506 | 0.2176 |
| Total RVUs | 17.1571 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$573.06
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.01 | 1 |
| Practice expense | 12.05 | 0.99 |
| Malpractice | 0.43 | 0.506 |
(5.01 × 1 + 12.05 × 0.99 + 0.43 × 0.506) × $33.4009 = $573.06
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.
31200 billing questions
How does this differ from 31201?
31200 describes removal of the anterior ethmoid portion. 31201 is the related intranasal code for total ethmoid removal, so the documented extent determines the choice.
When would an endoscopic ethmoidectomy code be more appropriate?
Use an endoscopic ethmoidectomy code when the surgeon performs the ethmoid work endoscopically. Codes 31254 and 31255 distinguish partial from total endoscopic ethmoidectomy.
What documentation supports 31200?
The operative report should identify the intranasal approach, the anterior ethmoid work performed, and the side treated. Record the extent clearly enough to distinguish anterior removal from total ethmoidectomy.
How is bilateral treatment reported?
For bilateral treatment, report modifier 50; CMS pays the bilateral procedure at 150%.
Can an assistant or co-surgeon be reported?
CMS does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
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.
3,5153117F,,Hf assessment tool completed,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
3,5163118F,,Ny heart assoc class docd,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
3,5173119F,,No eval activity clin symp,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
3,51831200,,Removal of ethmoid sinus,A,,5.01,12.05,NA,12.05,,0.43,17.49,17.49,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,51931201,,Removal of ethmoid sinus,A,,8.39,11.62,NA,11.62,,1.23,21.24,21.24,0,090,0.10,0.76,0.14,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,52031205,,Removal of ethmoid sinus,A,,10.32,13.94,NA,13.94,,0.92,25.18,25.18,0,090,0.10,0.76,0.14,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,5213120F,,12-lead ecg performed,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
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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817