No office rate
31255 describes total ethmoidectomy alone. Choose 31253 when the surgeon also explores the frontal sinus in the same operative service.
On this page
CMS RVU26D · Effective 2026-10-01
31253 Sinus endoscopy Medicare reimbursement rates in Vermont
Report this endoscopic sinus operation when the surgeon performs a total ethmoidectomy and explores the frontal sinus during the same procedure. Compare 31253 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 31253 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
$398.06
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.
Nasal/sinus endoscopy
About 31253: Endoscopic total ethmoidectomy with frontal exploration
Report this endoscopic sinus operation when the surgeon performs a total ethmoidectomy and explores the frontal sinus during the same procedure.
An otolaryngologist uses an endoscope through the nostril to remove ethmoid air cells as a total ethmoidectomy and access the frontal sinus. Frontal sinus tissue may also be removed when encountered. The operation is used for conditions such as chronic rhinosinusitis with obstructed frontal drainage or nasal polyps, and is typically performed in an operating room.
Select 31253 when the operative report supports both the total ethmoidectomy and frontal sinus exploration; document the work performed on each side. CMS applies endoscopy-family pricing when related endoscopies are performed together. For bilateral reporting, modifier 50 is paid at 150%. The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
CMS billing rules for 31253
- 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
- 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 RVU8.78 · 70%
- Practice expense (office) RVU2.51 · 20%
- Malpractice RVU1.29 · 10%
6.4K
Medicare services in 2024 · #1720 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.
31253 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
31276 describes frontal sinus exploration without the total ethmoidectomy. When both procedures are performed, 31253 describes their combination.
No office rate
31257 combines total ethmoidectomy with sphenoidotomy. 31253 pairs total ethmoidectomy with frontal sinus exploration instead.
$423.87
31254 represents partial ethmoidectomy. 31253 requires total ethmoidectomy and also includes frontal sinus exploration.
Compare 31253 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
$398.06
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 31253 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
3,534
- Code
- 31253
- Physician work
- 8.78
- Practice expense
- 2.51
- Malpractice
- 1.29
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 8.78 | × 1.000 | 8.7800 |
| Practice expense | 2.51 | × 0.990 | 2.4849 |
| Malpractice | 1.29 | × 0.506 | 0.6527 |
| Total RVUs | 11.9176 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$398.06
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 8.78 | 1 |
| Practice expense | 2.51 | 0.99 |
| Malpractice | 1.29 | 0.506 |
(8.78 × 1 + 2.51 × 0.99 + 1.29 × 0.506) × $33.4009 = $398.06
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.
31253 billing questions
When should 31253 be chosen instead of 31255?
Use 31253 when the surgeon performs a total ethmoidectomy and frontal sinus exploration. Code 31255 describes a total ethmoidectomy without the frontal sinus work.
Can 31255 or 31276 also be reported for the same operative work?
Do not separately report those codes for the total ethmoidectomy or frontal exploration already represented by 31253. CMS endoscopy-family pricing applies when related endoscopies are performed together.
How is bilateral 31253 reported?
Report modifier 50 for bilateral surgery; CMS pays the bilateral procedure at 150%. Document the work performed on both sides.
Does 31253 have a postoperative global period?
It has a 0-day global period. Same-day preoperative and postoperative care is included.
Can an assistant surgeon or co-surgeon be paid for 31253?
Medicare does not pay an assistant at surgery for this code. Co-surgeons and team surgery are not permitted.
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.
3,53131241,,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
3,53231242,,Nsl/sinus ndsc rf abltj pnn,A,,2.63,68.70,,1.02,,0.39,71.72,4.04,0,000,0.00,0.00,0.00,3,2,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53331243,,Nsl/sinus ndsc cryoabltj pnn,A,,2.63,66.62,,1.02,,0.39,69.64,4.04,0,000,0.00,0.00,0.00,3,2,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53431253,,Nsl/sins ndsc total,A,,8.78,2.51,NA,2.51,,1.29,12.58,12.58,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53531254,,Nsl/sins ndsc w/prtl ethmdct,A,,4.16,8.31,,1.40,,0.60,13.07,6.16,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53631255,,Nsl/sins ndsc w/tot ethmdct,A,,5.61,1.75,NA,1.75,,0.82,8.18,8.18,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
3,53731256,,Exploration maxillary sinus,A,,3.03,1.11,NA,1.11,,0.43,4.57,4.57,0,000,0.00,0.00,0.00,3,1,1,0,0,9,31231,33.4009,09,0,99,0.00,0.00,0.00
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