CPT 31238
Global 000 ActiveNsl/sins ndsc srg nsl hemrrg
CPT 31238 Billing & Documentation Guide
CPT code 31238 (Nsl/sins ndsc srg nsl hemrrg) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.67, a non-facility practice expense RVU of 4.73, and a malpractice RVU of 0.39, a total non-facility RVU of 7.79 and facility RVU of 4.32. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $267.03, though rates vary from $231.6 to $333.79 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 31238, 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 31238 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 31238 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 31238
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.67 | 2.67 |
| Practice Expense RVU | 4.73 | 1.26 |
| Malpractice RVU | 0.39 | 0.39 |
| Total RVU | 7.79 | 4.32 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 31238
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 | $286.38 | $149.24 | $270.83 - $333.79 | 29 |
| Florida | $273.05 | $156.76 | $259.79 - $286.59 | 3 |
| Georgia | $255.62 | $145.05 | $245.63 - $265.61 | 2 |
| Illinois | $267.04 | $155.05 | $253.78 - $278.48 | 4 |
| Michigan | $255.87 | $147.03 | $248.13 - $263.6 | 2 |
| North Carolina | $244.91 | $136.77 | $244.91 - $244.91 | 1 |
| New York | $287.37 | $158.07 | $248.42 - $306.92 | 5 |
| Ohio | $246.55 | $140.73 | $246.55 - $246.55 | 1 |
| Pennsylvania | $258.66 | $145.13 | $246.52 - $270.79 | 2 |
| Texas | $257.31 | $143.2 | $245.05 - $268.05 | 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 31238
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 31238 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 31238
What does CPT code 31238 mean? +
CPT code 31238 represents: Nsl/sins ndsc srg nsl hemrrg. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 31238? +
The 2026 Medicare national average non-facility payment for CPT 31238 is $267.03. Rates range from $231.6 to $333.79 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 31238? +
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 31238? +
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 May 31, 2026.
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