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CMS RVU26D · Effective 2026-10-01

31201 Ethmoidectomy Medicare reimbursement rates in Vermont

Reports total ethmoid air-cell removal through an intranasal approach for extensive ethmoid disease when the surgeon removes more than the anterior cells. Compare 31201 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 31201 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

$685.26

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.

Find 31201 in your payment locality →

Sinus surgery

About 31201: Intranasal total ethmoidectomy

Reports total ethmoid air-cell removal through an intranasal approach for extensive ethmoid disease when the surgeon removes more than the anterior cells.

This operation removes the ethmoid air cells through the nasal cavity using an intranasal approach rather than a sinus endoscope. An otolaryngologist typically performs it in an operating room for extensive ethmoid disease, such as chronic ethmoid sinusitis or diffuse polyposis, when total ethmoid removal is required. The code represents total, not anterior-only, ethmoidectomy and is distinct from an external approach or endoscopic ethmoidectomy.

Report the code when the operative documentation supports total ethmoidectomy by the intranasal route. Document the approach, extent, side or sides treated, and indication. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care through day 90. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Bilateral surgery reported with modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.

CMS billing rules for 31201

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 RVU8.39 · 40%
  • Practice expense (office) RVU11.62 · 55%
  • Malpractice RVU1.23 · 6%

41

Medicare services in 2024 · #5478 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.

31201 compared with similar codes

Office rates for Vermont, from the same CMS release.

31200

Ethmoidectomy

Anterior, intranasal approach

No office rate

Use 31200 for anterior intranasal ethmoid removal. This code is for total ethmoidectomy through the intranasal approach.

31205

Ethmoidectomy

Intranasal, anterior

No office rate

Both describe total ethmoid removal, but 31205 uses an external approach; this code uses an intranasal approach.

31254

Ethmoidectomy

Partial, anterior ethmoid

$423.87

31254 is endoscopic partial ethmoidectomy. This code represents total ethmoidectomy by the intranasal approach.

31255

Ethmoidectomy

Total, anterior and posterior cells

No office rate

Both represent total ethmoidectomy, but 31255 is performed endoscopically; this code is for the intranasal approach.

Compare 31201 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

Office and facility base rates · shared scale starting at $0

  • Vermont →

    Office / nonfacility

    Unavailable

    Facility

    $685.26

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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 31201 in Vermont.

PPRRVU2026_Oct_nonQPP.csv

3,519

Code
31201
Physician work
8.39
Practice expense
11.62
Malpractice
1.23

GPCI2026.csv

105

Locality
Vermont
Physician work
1.000
Practice expense
0.990
Malpractice
0.506
Facility calculation for 31201 in Vermont
ComponentRVULocality factorAdjusted
Physician work8.39× 1.0008.3900
Practice expense11.62× 0.99011.5038
Malpractice1.23× 0.5060.6224
Total RVUs20.5162
Conversion factor× 33.4009

Facility rate, Vermont$685.26

Values as parsed from CMS release RVU26D, effective 2026-10-01. The amount is rounded to the nearest cent only at the end.
Explore RVUs, geographic factors and the full formula

Facility

Facility calculation inputs
ComponentRVULocal GPCI
Work8.391
Practice expense11.620.99
Malpractice1.230.506

(8.39 × 1 + 11.62 × 0.99 + 1.23 × 0.506) × $33.4009 = $685.26

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.

31201 billing questions

How does this differ from code 31200?

This code represents total intranasal ethmoidectomy. Code 31200 is for anterior ethmoidectomy, so the documented extent of removal determines which code fits.

How does this differ from code 31255?

Code 31255 describes total ethmoidectomy performed endoscopically. This code is for the intranasal approach.

Can modifier 50 be reported for bilateral surgery?

Yes. CMS lists this as a bilateral procedure; when reported with modifier 50, it is paid at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and related postoperative care through 90 days after surgery.

Can an assistant or co-surgeon be paid?

CMS lists a statutory restriction on assistant-at-surgery payment. Co-surgeons and team surgery are not permitted.

What documentation supports reporting total ethmoidectomy?

The operative report should establish the intranasal approach and total rather than anterior-only ethmoid removal, and identify the side or sides treated.

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.

RVUs for 31201PPRRVU2026_Oct_nonQPP.csv, line 3,519 (RVU26D)
Geographic factors for VermontGPCI2026.csv, line 105 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet