CPT 31200
Global 090 ActiveRemoval of ethmoid sinus
CPT 31200 Billing & Documentation Guide
CPT code 31200 (Removal of ethmoid sinus) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 5.01, a non-facility practice expense RVU of 12.05, and a malpractice RVU of 0.43, a total non-facility RVU of 17.49 and facility RVU of 17.49. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $603.1, though rates vary from $520.47 to $773.82 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 31200, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 31200 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 31200 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 31200
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 5.01 | 5.01 |
| Practice Expense RVU | 12.05 | 12.05 |
| Malpractice RVU | 0.43 | 0.43 |
| Total RVU | 17.49 | 17.49 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 31200
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $657.37 | $657.37 | $619 - $773.82 | 29 |
| Florida | $599.12 | $599.12 | $573.7 - $622.64 | 3 |
| Georgia | $568.74 | $568.74 | $543.47 - $594.01 | 2 |
| Illinois | $584.27 | $584.27 | $557.25 - $607.31 | 4 |
| Michigan | $565.49 | $565.49 | $551.02 - $579.95 | 2 |
| North Carolina | $552.03 | $552.03 | $552.03 - $552.03 | 1 |
| New York | $643.8 | $643.8 | $559.79 - $683.27 | 5 |
| Ohio | $549.28 | $549.28 | $549.28 - $549.28 | 1 |
| Pennsylvania | $578.43 | $578.43 | $550.39 - $606.47 | 2 |
| Texas | $577.84 | $577.84 | $546.94 - $606.22 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 31200
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 31200 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 31200
What does CPT code 31200 mean? +
CPT code 31200 represents: Removal of ethmoid sinus. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 090.
What is the Medicare reimbursement for CPT 31200? +
The 2026 Medicare national average non-facility payment for CPT 31200 is $603.1. Rates range from $520.47 to $773.82 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 31200? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 31200? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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