Balloon surgery code overview

Below, find an overview of Endoscopic Sinus Ostial Dilation Surgery codes, with Medicare national averages for payment for a clinic based unilateral procedure. To visit the CMS webpage, click here. To download the one page resource "Sino-nasal Procedures Coding Summary," click here.

Endoscopic Sinus Ostial Dilation (e.g. Balloon) Surgery Codes  Nat'l Avg
31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa
$2,104
31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, balloon dilation) $2,136
31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation) $2,101
Misc Codes
C1726 Catheter, balloon dilatation, non-vascular N/A

A surgical sinus endoscopy includes a sinustomy (when appropriate) and a diagnostic endoscopy

  • 31295-31297 describe dilation of sinus ostia by displacement of tissue
  • 31295-31297 are used to report unilateral procedures unless otherwise specified (modifier -50 bilateral)

Codes obtained from AMA CPT 2011 codebook, pages 153-155; CPT Changes 2011 pages 37-38; CPT 2011 Annual Symposium

C code-catheter device code (HOPD only) will not trigger additional payment to the outpatient hospital facility. Code is used to assist Medicare in establishing future APC rates. Medicare requires hospitals to report all device category codes (C-codes) on Medicare outpatient claims when medical devices are used in conjunction with procedure(s) billed for cost data collection and claims processing. Failure to add the appropriate device code will result in the claim to be returned.

Society policy statements for the role of balloon sinus dilation in the treament of sinusitis

The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has released a policy statement affirming the role of balloon sinus dilation in the treatment of select patients with sinusitis.

Click here to view the AAO-HNS balloon dilation policy statement.

Click here to view AAO Clinical Indicators for Endoscopic Sinus Surgery (including balloon dilation codes).

Additional coding resources

Current customers: More reimbursment information and tools are available from the Entellus Reimbursement Access team on the Entellus Advantage Resource Portal. To login, click here.

More information on balloon sinus dilation coding can also be found at: http://www.entnet.org/Practice/Coding-for-Balloon-Sinus-Dilation-2010.cfm

To discuss your reimbursment questions with a member of the Entellus Reimbursement Access team, click here to contact.