How much does Medicare pay for CPT 31296?

Medicare allowed an average of $1854.89 per service and paid $1473.36 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $8482.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31296?

Dilation of frontal nasal sinus using an endoscope. It was billed 1,619 times to 1,605 Medicare beneficiaries by 69 providers in 2024.

Does 31296 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1869.96 in an office setting and $707.90 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 31296 most?

Otolaryngology, with 1,340 services from 51 clinicians. Next are Physician Assistant, Nurse Practitioner, Ambulatory Surgical Center.

CPT 31296

Dilation of frontal nasal sinus using an endoscope

$1854.89Medicare-allowed amount per service, averaged across 1,619 services

Providers submitted

$8482.74

Asking price, not received

Medicare allowed

$1854.89

The fee schedule figure

Medicare paid

$1473.36

Balance is patient coinsurance

Providers submitted an average of $8482.74 for this code and Medicare allowed $1854.89 — 4.6× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $1473.36 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1869.96
Hospital / facility: $707.90

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 1,598 services were billed in an office setting and 21 in a facility.

Services: 1,619
Beneficiaries: 1,605
Providers billing it: 69
Total allowed: $3,003,067

What Medicare pays for CPT 31296

Across 1,619 services billed by 69 providers to 1,605 beneficiaries, Medicare allowed an average of $1854.89 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 31296

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	1,340	1,337	$2169.09	51
Physician Assistant	149	148	$313.59	10
Nurse Practitioner	109	109	$320.11	7
Ambulatory Surgical Center	21	11	$707.90	1

31296 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Illinois	416	$1592.24	$1164.51	14
Wisconsin	240	$1488.68	$1154.38	11
Florida	129	$1991.70	$1327.49	6
Texas	127	$1950.06	$1460.31	8
California	120	$2666.92	$1793.39	3
Indiana	113	$1732.19	$1451.98	6
Nevada	77	$2323.43	$1723.31	1
South Carolina	69	$1837.26	$1202.87	3
North Carolina	47	$1991.60	$1432.34	2
Arizona	38	$2233.82	$1500.06	2
Connecticut	36	$2281.34	$1448.93	1
Tennessee	34	$1839.54	$1167.83	1
New Jersey	25	$2662.12	$1641.24	2
Alabama	24	$1886.48	$1789.36	1
Kansas	24	$1789.07	$1543.82	1
Maryland	18	$1839.75	$1001.95	1
Minnesota	17	$1990.41	$1515.68	1
Oregon	15	$1635.69	$875.06	1
Idaho	14	$1868.41	$1249.55	1
Georgia	13	$1799.77	$1074.29	1
Ohio	12	$1871.35	$1637.80	1
Mississippi	11	$1450.13	$1055.12	1

Related codes

31231Diagnostic exam of nasal passages$169.68
31237Biopsy or removal of nasal polyp or tissue$327.59
31295Dilation of nasal sinus$1974.90
31267Removal of nasal sinus tissue$951.39
31238Control of bleeding of nose$260.10
31298Dilation of sphenoid and frontal nasal sinus$4271.74
31276Exploration of nasal sinus$1053.25
31233Exam of nasal passage and sinus$337.56
31254Partial removal of nasal sinus$582.71
31256Incision of nasal sinus$535.88
31242Destruction of nasal nerve by heat$2439.75
31259Removal of tissue from sphenoid sinus$850.44

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.