Balloon Dilation and
Endoscopic Sinus Surgery
REIMBURSEMENT CODING GUIDE
This document provides general reimbursement information to assist in
obtaining coverage and reimbursement for healthcare services. These coding
suggestions do not replace seeking coding advice from the payer and/or
your own coding staff. The ultimate responsibility for correct coding lies with
the provider of services. Please contact your local payer for interpretation of
the appropriate codes to use for specific procedures.
Current Procedural Terminology (CPT) Copyright 2015, American Medical Association. All Rights Reserved.
Please direct any questions to:
Patty Telgener, RN, CPC
Vice President, Reimbursement Services
Emerson Consultants
(303) 526-7604 (office)
[email protected]
Balloon Dilation Codes and Endoscopic Sinus Surgery Codes
CPT codes 31295, 31296 and 31297 apply to cases in which a balloon catheter is the only instrument/tool used and no
tissue is removed. Do not report 31295, 31296 or 31297 with endoscopic sinus surgery codes if performed together. As
medically necessary, the use of a stereotactic guidance system may be reported in addition to the appropriate codes for
the primary ENT procedure. Documentation should explain both the medical necessity and pre-planning activities. CPT
codes 61781, 61782, and 61783 are “add-on” codes and must be reported in addition to the primary procedure.
NASAL/SINUS ENDOSCOPIC SURGERY CODING GUIDE - 2015
Physician Coding
CPT
Code1
Description1
30140
RELATIVE VALUE UNITS
(RVUs)2
2015 NATIONAL
AVERAGE MEDICARE
ALLOWABLE2
Global
Facility
Non‐Facility
Facility
Non‐
Facility
Submucous resection, inferior turbinate,
partial or complete, any method
090
12.56
12.56
$449
$449
30420
Rhinoplasty, primary; including major
septal repair
090
39.18
39.18
$1,401
$1,401
30520
Septoplasty or submucous resection,
with or without cartilage scoring,
contouring or replacement with graft
090
17.78
17.78
$636
$636
30801
Cautery and/or ablation, mucosa of
inferior turbinates, unilateral or bilateral,
any method; superficial
010
3.91
6.52
$140
$233
31000
Lavage by cannulation; maxillary sinus
(antrum puncture or natural ostium)
010
3.04
5.24
$108
$187
31002
Lavage by cannulation; sphenoid sinus
(antrum puncture or natural ostium)
010
5.51
5.51
$197
$197
31231
Nasal endoscopy, diagnostic, unilateral
or bilateral (separate procedure)
000
1.88
5.97
$67
$213
31233
Diagnostic endoscopy of nose and
maxillary sinus via inferior
meatus puncture
000
3.94
7.49
$141
$268
31237
Nasal/sinus endoscopy, surgical; with
biopsy, polypectomy or debridements
(separate procedure)
000
4.64
7.37
$166
$264
31238
Surgical endoscopy of nose with
control of nasal hemorrhage
000
4.87
7.36
174
$263
31240
Nasal/sinus endoscopy, surgical; with
concha bullosa resection
000
4.63
4.63
$166
$166
31254
Nasal/sinus endoscopy, surgical; with
ethmoidectomy, partial (anterior)
000
7.87
7.87
$281
$281
NASAL/SINUS ENDOSCOPIC SURGERY CODING GUIDE - 2015
Physician Coding
CPT
Code1
Description1
RELATIVE VALUE UNITS
(RVUs)2
2014 NATIONAL
AVERAGE MEDICARE
ALLOWABLE
Global
Facility
Non‐Facility
Facility
Non‐Facility
31255
Nasal/sinus endoscopy, surgical; with
ethmoidectomy, total (anterior and
posterior)
000
11.53
11.53
$412
$412
31256
Nasal/sinus endoscopy, surgical, with
maxillary antrostomy
000
5.71
5.71
$204
$204
31267
Nasal/sinus endoscopy, surgical, with
maxillary antrostomy; with removal of
tissue from maxillary sinus
000
9.16
9.16
$327
$327
31276
Nasal/sinus endoscopy, surgical with
frontal sinus exploration; with or
without removal of tissue from frontal
sinus
000
14.53
14.53
$520
$520
31287
Nasal/sinus endoscopy, surgical, with
sphenoidotomy
000
6.69
6.69
$239
$239
31288
Nasal/sinus endoscopy, surgical, with
sphenoidotomy; with removal of tissue
from the sphenoid sinus
000
7.76
7.76
$277
$277
31295
Nasal/sinus endoscopy, surgical; with
dilation of maxillary sinus ostium (e.g.
balloon dilation), transnasal or via
canine fossa
000
4.82
58.37
$172
$2,087
31296
With dilation of frontal sinus ostium
(e.g. balloon dilation)
000
5.75
59.19
$206
$2,116
31297
With dilation of sphenoid sinus
ostium (e.g. balloon dilation)
000
4.71
58.12
$168
$2,078
61782
Stereotactic computer-assisted
(navigational) procedure, cranial,
extradural
N/A
5.10
5.10
$182
$182
1. Current Procedural Terminology (CPT®). Copyright 2015 American Medical Association.
2. C
MS CY2015 Final Physician Rule - Federal Register Vol. 79; National Physician Fee Schedule Relative Value File January 2015 Release; Conversion Factor 35.7547.
Effective through March 31, 2015.
HCPCS CODES APPLICABLE TO NUVENT™ EM SINUS DILATION SYSTEM
C1726 - Catheter, balloon dilatation, non-vascular
NASAL/SINUS ENDOSCOPIC SURGERY CODING GUIDE - 2015
Hospital Outpatient and ASC Coding
MEDICARE OUTPATIENT PROSPECTIVE PAYMENT
SYSTEM (OPPS)
AMBULATORY
SURGERY2
HOSPITAL OUTPATIENT2
APC
2015 MEDICARE
NATIONAL
PAYMENT
STATUS
INDICATOR3
2015 MEDICARE
NATIONAL
PAYMENT
Submucous resection, inferior turbinate,
partial or complete, any method
0254
$1,946
T
$1,066
30420
Rhinoplasty, primary; including major
septal repair
0256
$3,730
T
2,044
30520
Septoplasty or submucous resection,
with or without cartilage scoring,
contouring or replacement with graft
0254
$1,946
T
$1,066
30801
Cautery and/or ablation, mucosa of
inferior turbinates, unilateral or bilateral,
any method; superficial
0252
$647
T
$354
31000
Lavage by cannulation; maxillary sinus
(antrum puncture or natural ostium)
0251
$363
T
$138
31002
Lavage by cannulation; sphenoid sinus
(antrum puncture or natural ostium)
0252
$647
T
$354
31231
Nasal endoscopy, diagnostic, unilateral
or bilateral (separate procedure)
0071
$151
T
$83
31233
Diagnostic endoscopy of nose and
maxillary sinus via inferior
meatus puncture
0072
$386
T
$212
31237
Nasal/sinus endoscopy, surgical; with
biopsy, polypectomy or debridements
(separate procedure)
0073
$1,259
T
$690
31238
Surgical endoscopy of nose with
control of nasal hemorrhage
0073
$1,259
T
$690
31240
Nasal/sinus endoscopy, surgical; with
concha bullosa resection
0074
$2,010
T
$1,101
31254
Nasal/sinus endoscopy, surgical; with
ethmoidectomy, partial (anterior)
0074
$2,010
T
$1,101
31255
Nasal/sinus endoscopy, surgical; with
ethmoidectomy, total (anterior and
posterior)
0075
$3,071
T
$1,683
CPT
Code1
Description
30140
1
NASAL/SINUS ENDOSCOPIC SURGERY CODING GUIDE - 2015
Hospital Outpatient and ASC Coding
MEDICARE OUTPATIENT PROSPECTIVE PAYMENT
SYSTEM (OPPS)
AMBULATORY
SURGERY2
HOSPITAL OUTPATIENT2
CPT
Code1
Description1
APC
2015 MEDICARE
NATIONAL
PAYMENT
STATUS
INDICATOR3
2015 MEDICARE
NATIONAL
PAYMENT
31256
Nasal/sinus endoscopy, surgical, with
maxillary antrostomy
0074
$2,010
T
$1,101
31267
Nasal/sinus endoscopy, surgical, with
maxillary antrostomy; with removal of
tissue from maxillary sinus
0074
$2,010
T
$1,101
31276
Nasal/sinus endoscopy, surgical with
frontal sinus exploration; with or
without removal of tissue from frontal
sinus
0075
$3,070
T
$1,683
31287
Nasal/sinus endoscopy, surgical, with
sphenoidotomy
0075
$3,070
T
$1,683
31288
Nasal/sinus endoscopy, surgical, with
sphenoidotomy; with removal of tissue
from the sphenoid sinus
0075
$3,070
T
$1,683
31295
Nasal/sinus endoscopy, surgical; with
dilation of maxillary sinus ostium (e.g.
balloon dilation), transnasal or via
canine fossa
0075
$3,070
T
$1,683
31296
With dilation of frontal sinus ostium
(e.g. balloon dilation)
0075
$3,070
T
$1,683
31297
With dilation of sphenoid sinus
ostium (e.g. balloon dilation)
0074
$2,010
T
$1,101
61782
Stereotactic computer-assisted
(navigational)
N/A
Packaged
N
Packaged
1. Current Procedural Terminology (CPT ®). Copyright 2015 American Medical Association.
2. CMS Final 2015 Outpatient Rule - CMS-1613-FC. Fee schedules are national averages and are not geographically adjusted.
3. Status Indicator of “T” means separate APC payment, multiple reduction applies.
Rx only. Refer to product instruction manual/package
insert for instructions, warnings, precautions, and
contraindications.
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UC201500398aEN 02.2015
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