CPT 31254
Global 000 ActiveNsl/sins ndsc w/prtl ethmdct
CPT 31254 Billing & Documentation Guide
CPT code 31254 (Nsl/sins ndsc w/prtl ethmdct) is classified under Surgery (Respiratory/Cardiovascular) with a global period indicator of 000. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 4.16, a non-facility practice expense RVU of 8.31, and a malpractice RVU of 0.6, a total non-facility RVU of 13.07 and facility RVU of 6.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $448.61, though rates vary from $387.69 to $565.22 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 31254, 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 31254 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 31254 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 31254
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 4.16 | 4.16 |
| Practice Expense RVU | 8.31 | 1.4 |
| Malpractice RVU | 0.6 | 0.6 |
| Total RVU | 13.07 | 6.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 31254
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 | $483.23 | $210.12 | $456.26 - $565.22 | 29 |
| Florida | $456.45 | $224.88 | $434.42 - $478.57 | 3 |
| Georgia | $427.93 | $207.75 | $410.42 - $445.44 | 2 |
| Illinois | $445.93 | $222.92 | $423.68 - $464.86 | 4 |
| Michigan | $427.78 | $211.07 | $414.99 - $440.58 | 2 |
| North Carolina | $410.72 | $195.38 | $410.72 - $410.72 | 1 |
| New York | $482.43 | $224.95 | $416.72 - $515.08 | 5 |
| Ohio | $412.56 | $201.84 | $412.56 - $412.56 | 1 |
| Pennsylvania | $433.5 | $207.43 | $412.69 - $454.3 | 2 |
| Texas | $431.59 | $204.36 | $410.15 - $450.64 | 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 31254
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 31254 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 |
| 0407T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 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 |
Frequently Asked Questions, CPT 31254
What does CPT code 31254 mean? +
CPT code 31254 represents: Nsl/sins ndsc w/prtl ethmdct. It's in the Surgery (Respiratory/Cardiovascular) category with a global period of 000.
What is the Medicare reimbursement for CPT 31254? +
The 2026 Medicare national average non-facility payment for CPT 31254 is $448.61. Rates range from $387.69 to $565.22 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 31254? +
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 31254? +
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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