$189.23
31231 is diagnostic nasal endoscopy. Choose 31238 when the endoscopic encounter includes surgical treatment of nasal hemorrhage.
On this page
CMS RVU26D · Effective 2026-10-01
31238 Nasal endoscopy Medicare reimbursement rates in Vermont
Endoscopic surgical treatment of nasal bleeding, reported when the provider uses a nasal endoscope to locate and control a hemorrhage. Compare 31238 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 31238 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
$252.18
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$137.44
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.
Nasal endoscopy
About 31238: Endoscopic control of nasal hemorrhage
Endoscopic surgical treatment of nasal bleeding, reported when the provider uses a nasal endoscope to locate and control a hemorrhage.
An otolaryngologist typically uses a nasal endoscope to find and treat a bleeding site, often when epistaxis persists despite packing or other initial measures. The surgeon may cauterize or otherwise surgically control the source. The procedure is commonly performed in an operating room or procedure setting, with anesthesia as clinically appropriate.
Report this code when the documented service is endoscopic surgical control of nasal bleeding, rather than diagnostic inspection alone or control performed without endoscopy. The record should describe the bleeding site, side, operative method, and reason for intervention. This minor procedure has a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy-family pricing applies. Modifier 50 identifies bilateral services and is paid at 150%. An assistant is paid only when medical necessity is documented; co-surgeons and team surgery are not permitted.
CMS billing rules for 31238
- 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 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 RVU2.67 · 34%
- Practice expense (office) RVU4.73 · 61%
- Malpractice RVU0.39 · 5%
21.5K
Medicare services in 2024 · #1119 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.
31238 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
31241 identifies endoscopic ligation of the sphenopalatine artery. Use it when that specific operation is performed, rather than reporting general endoscopic hemorrhage control.
$259.19
30903 describes complex anterior nasal bleeding control without the endoscopic surgical approach represented by 31238.
$385.85
30905 describes nonendoscopic control of posterior nasal bleeding; 31238 requires endoscopic surgical control.
Compare 31238 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
$252.18
Facility
$137.44
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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 31238 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,528
- Code
- 31238
- Physician work
- 2.67
- Practice expense
- 4.73
- Malpractice
- 0.39
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.67 | × 1.000 | 2.6700 |
| Practice expense | 4.73 | × 0.990 | 4.6827 |
| Malpractice | 0.39 | × 0.506 | 0.1973 |
| Total RVUs | 7.5500 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$252.18
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.67 | 1 |
| Practice expense | 4.73 | 0.99 |
| Malpractice | 0.39 | 0.506 |
(2.67 × 1 + 4.73 × 0.99 + 0.39 × 0.506) × $33.4009 = $252.18
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.67 | 1 |
| Practice expense | 1.26 | 0.99 |
| Malpractice | 0.39 | 0.506 |
(2.67 × 1 + 1.26 × 0.99 + 0.39 × 0.506) × $33.4009 = $137.44
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.
31238 billing questions
When should 31238 be chosen instead of a diagnostic nasal endoscopy?
Use 31238 when the endoscopic service includes surgical control of nasal bleeding. A diagnostic examination without operative hemorrhage control is described by 31231.
How does 31238 differ from nasal packing or cautery codes?
31238 describes surgical hemorrhage control performed endoscopically. Codes such as 30903 or 30905 describe nonendoscopic control in the applicable anterior or posterior bleeding situation.
When is modifier 50 appropriate?
Use modifier 50 when the procedure is performed bilaterally. CMS pays the bilateral procedure at 150%.
Can 31231 be reported separately for the operative examination?
A diagnostic look that is part of the endoscopic surgical control is not a separate diagnostic service. Report 31231 only when a distinct diagnostic examination is performed and documented.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment requires documentation of 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.
3,52531233,,Nsl/sins ndsc dx max sinusc,A,,2.13,5.73,,1.08,,0.30,8.16,3.51,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52631235,,Nsl/sins ndsc dx sphn sinusc,A,,2.57,6.35,,1.19,,0.37,9.29,4.13,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52731237,,Nsl/sins ndsc surg bx polypc,A,,2.54,5.07,,1.23,,0.37,7.98,4.14,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52831238,,Nsl/sins ndsc srg nsl hemrrg,A,,2.67,4.73,,1.26,,0.39,7.79,4.32,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,52931239,,Nsl/sinus endoscopy surg dcr,A,,8.81,5.91,NA,5.91,,0.99,15.71,15.71,0,010,0.10,0.80,0.10,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53031240,,Nsl/sns ndsc cnch bull rescj,A,,2.54,1.18,NA,1.18,,0.37,4.09,4.09,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53131241,,Nsl/sns ndsc lig sphnptn art,A,,7.80,2.23,NA,2.23,,1.14,11.17,11.17,0,000,0.00,0.00,0.00,3,1,0,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
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