CPT code 31243: Nasal nerve ablation2026 Medicare rate & RVUs in Washington
Endoscopic cryoablation of the posterior nasal nerve treats chronic rhinitis by targeting nasal nerve tissue through the nasal cavity.
Medicare pays $2,442.00–$2,833.16 for 31243 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 31243 covers
An otolaryngologist uses a nasal endoscope to guide a cryoprobe to the posterior nasal nerve region and ablate the nerve tissue. The procedure is used for chronic rhinitis, including persistent nasal symptoms such as congestion and drainage, and may be performed in an office or facility setting. The code represents the cryotherapy approach, not radiofrequency treatment.
Report the service when the documented procedure uses endoscopic guidance and cryoablation of the posterior nasal nerve. Record the indication, endoscopic approach, cryotherapy technique, and treated sides. CMS prices this code as bilateral, so modifier 50 does not increase payment. It has a 0-day global period, which includes same-day preoperative and postoperative care. When related endoscopies are performed together, endoscopy family pricing applies. Medicare does not pay an assistant at surgery for this service; co-surgeons and team surgery are not permitted.
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.
Where 31243 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $2,442.00 | $134.77 |
| Seattle (King Cnty) | $2,833.16 | $144.68 |
How the 31243 rate is calculated
Each of 31243’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 31243
RVUs × geographic indexes × conversion factor
Work2.63
2.63 RVUs× 1.000 GPCI
Practice expense66.62
66.62 RVUs× 1.000 GPCI
Malpractice0.39
0.39 RVUs× 1.000 GPCI
Adjusted RVUs
69.6400
Conversion factor
$33.4009
Medicare rate
$2,326.04
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 31243
The CMS indicators that decide how 31243 is paid alongside other services.
CMS payment indicators · 31243
Nasal nerve ablation
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 2 | Already bilateral by definition: paid once at 100%. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
31243 without 51 · national office
$2,326.04
Nasal nerve ablation
31243-51 · Second procedure: 50%
$1,163.02
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
31243 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 31242Nerve ablation
- Use 31243 for cryoablation of the posterior nasal nerve; use 31242 when the documented method is radiofrequency ablation.
- 31231Nasal endoscopy
- 31231 describes diagnostic nasal endoscopy. It does not represent cryoablation of the posterior nasal nerve.
- 31237Nasal endoscopy
- 31237 covers endoscopic biopsy or polyp removal. It applies to tissue sampling or removal, not posterior nasal nerve cryoablation.
31243 billing questions
How does this differ from 31242?
Both codes describe endoscopic posterior nasal nerve ablation, but 31243 is for cryotherapy and 31242 is for radiofrequency treatment. Choose the code that matches the documented ablation method.
Should the code be reported once or once per side?
CMS prices 31243 as bilateral. Report the service once; modifier 50 does not increase payment.
What documentation supports 31243?
Document the chronic rhinitis indication, endoscopic access, use of cryotherapy to ablate the posterior nasal nerve, and the sides treated.
Can a diagnostic nasal endoscopy also be reported?
Endoscopic visualization used to guide the cryoablation is part of the surgical service. A separate diagnostic endoscopy requires a distinct, medically necessary service beyond that procedural guidance.
How does the 0-day global period affect same-day care?
Same-day preoperative and postoperative care is included in the procedure's 0-day global period.
Can an assistant or co-surgeon be billed?
Medicare does not pay an assistant at surgery for 31243. 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 indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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