CPT 31231
Global 000 ActiveNasal endoscopy dx
CPT 31231 Billing & Documentation Guide
CPT code 31231 (Nasal endoscopy dx) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.07, a non-facility practice expense RVU of 4.56, and a malpractice RVU of 0.16, a total non-facility RVU of 5.79 and facility RVU of 1.64. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $200, though rates vary from $169.32 to $262.16 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 31231, 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 31231 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Endoscopic or minor procedure with related preoperative and postoperative work performed on the same day
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 31231 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 31231
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.07 | 1.07 |
| Practice Expense RVU | 4.56 | 0.41 |
| Malpractice RVU | 0.16 | 0.16 |
| Total RVU | 5.79 | 1.64 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 31231
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 | $220.14 | $56.12 | $206.14 - $262.16 | 29 |
| Florida | $198.96 | $59.88 | $189.38 - $207.81 | 3 |
| Georgia | $187.49 | $55.25 | $177.97 - $197.01 | 2 |
| Illinois | $193.24 | $59.31 | $183.15 - $201.88 | 4 |
| Michigan | $186.28 | $56.12 | $180.83 - $191.73 | 2 |
| North Carolina | $181.26 | $51.93 | $181.26 - $181.26 | 1 |
| New York | $214.61 | $59.98 | $184.19 - $229.04 | 5 |
| Ohio | $180.18 | $53.63 | $180.18 - $180.18 | 1 |
| Pennsylvania | $190.96 | $55.19 | $180.61 - $201.31 | 2 |
| Texas | $190.85 | $54.38 | $179.3 - $201.69 | 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 31231
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 31231 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 | CPT Separate procedure definition |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | CPT Separate procedure definition |
Frequently Asked Questions, CPT 31231
What does CPT code 31231 mean? +
CPT code 31231 represents: Nasal endoscopy dx. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 31231? +
The 2026 Medicare national average non-facility payment for CPT 31231 is $200. Rates range from $169.32 to $262.16 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 31231? +
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 31231? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team