CPT Code 31296

2026 Medicare national rate

Medicare payment = total RVUs × GPCI (locality adjustment) × conversion factor. At the national level (GPCI = 1.0), 48.00 × 33.4009 = $1603.24 (office). Facility rates are lower because the facility separately bills its overhead.

RVU breakdown

PC/TC: Physician service — not subject to a professional/technical split.

Billing notes

• Medicare pays $1450.93 more for 31296 in an office ($1603.24) than in a facility ($152.31). The office (non-facility) rate carries the practice-expense overhead a hospital or ASC bills separately, so the place-of-service code you submit directly changes the allowable.
• 31296 has a 0-day global period, so a separately identifiable E/M on the same day may be reported with modifier 25 when the documentation supports it.
• The national allowable is built from 48.00 total office RVUs × the $33.4009 conversion factor; multiply by your locality GPCIs (above) to reconcile a specific remittance.

Billing & payment rules

Multiple procedures

Special endoscopic multiple-procedure rules apply.

Bilateral surgery

Conditional bilateral — 150% adjustment applies when performed bilaterally (modifier 50).

Assistant surgeon

Assistant surgeon may be paid.

Co-surgeons

Co-surgeons not permitted.

Team surgeons

Team surgeons not permitted.

Global period

0-day global period — no built-in postoperative period; a separately identifiable same-day E/M (modifier 25) may be billable.

2026 rate by locality

Computed from CMS 2026 GPCIs: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × $33.4009. Your MAC's locality may differ.

Related Surgery codes

Related guides

• Modifier 25: When to Use It and Common Mistakes
• Medical Billing Modifier Cheat Sheet: The 20 Modifiers You Actually Use