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    v1.0.30
    OpenPayerBilling CodesEndoscopy Procedures on the Accessory SinusesCPT cpt-31235-sphenoid-sinus-diagnostic-endoscopy
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    CPT 31235: Diagnostic Endoscopy of Sphenoid Sinus

    Medicare pays $321 on average nationally for this procedure.

    CPT code 31235 describes a diagnostic endoscopy of the sphenoid sinus, performed either via puncture or through the sinus's natural ostium; the service is an endoscopic diagnostic sinus procedure typically performed in an operating room or endoscopy suite (ambulatory surgical center or hospital outpatient setting) using nasal endoscopic access to visualize the sphenoid sinus and evaluate pathology or obtain samples.

    For related coverage guidance, see recent payer policy updates: Dental Anesthesia Services, Anesthesia Services for Interventional Pain Management Procedures in an Adult, General Anesthesia and Conscious Sedation Services.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult presenting to an otolaryngology clinic or an ambulatory surgery center with recurrent or persistent sphenoid sinus symptoms such as deep-seated retro-orbital pressure, persistent post-nasal drip, or refractory sinusitis despite medical therapy. After clinical evaluation and CT imaging suggest isolated sphenoid sinus disease (mucous retention cyst, focal opacification, or suspected fungal infection), the provider schedules a diagnostic sphenoid endoscopy to directly visualize the sphenoid sinus ostium. The procedure is performed under local anesthesia with sedation or general anesthesia depending on patient tolerance and comorbidities. Endoscopic access is obtained through the nasal cavity via the natural ostium or via a puncture approach to sample sinus contents, inspect mucosa, and obtain cultures or tissue biopsy. Typical workflow includes preoperative consent, image review, intraoperative endoscopic inspection with targeted sampling, hemostasis, and brief recovery. This procedure is commonly performed in the ambulatory surgical center or hospital outpatient department when diagnostic sampling or direct visualization of the sphenoid sinus is required.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    31237Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)May be performed if biopsy or debridement of sphenoid sinus mucosa is required beyond diagnostic visualization
    31276Nasal/sinus endoscopy, surgical; with dilation of frontal or sphenoid sinus ostiumPerformed when the diagnostic endoscopy identifies obstructive anatomy requiring dilation of the sphenoid ostium
    31267Nasal/sinus endoscopy, surgical; with removal of impacted tissue or foreign bodyUsed when endoscopic removal of impacted material from the sphenoid is undertaken during the same session
    31575Laryngoscopy, flexible or rigid, diagnosticMay be performed in the same setting for concurrent evaluation of adjacent airway structures
    31231Nasal/sinus endoscopy, diagnostic; with biopsy, or culture of nasal/sinus mucosaSimilar diagnostic utility for other paranasal sinuses and may be billed when multiple sinus sites are sampled

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    79Modifier 79 indicates a surgical procedure performed during the postoperative global period of a prior surgery that is unrelated to the original procedure. Per AMA/CPT and CMS guidance, it is…- Use modifier 79 when the same physician (or same‑specialty physician in the same group) performs a surgical procedure during the postoperative global period of a prior surgery and the new procedure…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207P00000X
    2084P0800X
    207L00000X
    364S00000X
    363A00000X
    2251N0400X
    282E00000X
    171M00000X

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    A49.9Bacterial infection, unspecified
    B95.3Streptococcus pneumoniae as the cause of diseases classified elsewhere
    D86.2Sarcoidosis of lung with sarcoidosis of lymph nodes
    G47.33Obstructive sleep apnea (adult) (pediatric)
    H57.10Ocular pain, unspecified eye
    H93.13Tinnitus, bilateral
    J01.00Acute maxillary sinusitis, unspecified
    J01.01Acute recurrent maxillary sinusitis
    J01.90Acute sinusitis, unspecified
    J01.91Acute recurrent sinusitis, unspecified

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    10 rows

    PolicyPayerEffective Date
    Dental Anesthesia ServicesProvidence Health Plan2026-10-01
    Anesthesia Services for Interventional Pain Management Procedures in an AdultCigna2026-09-15
    General Anesthesia and Conscious Sedation ServicesUnitedHealthcare2026-09-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21

    Related Codes

    CPT-31231-DIAGNOSTIC-NASAL-ENDOSCOPY-NASAL-CAVITY-EVALUATION

    CPT 31231: Nasal Endoscopy, Diagnostic

    CPT-31233-MAXILLARY-SINUS-DIAGNOSTIC-ENDOSCOPY-THROUGH-CANINE-FOSSA-OR-INFERIOR-MEATUS

    CPT 31233: Diagnostic Endoscopy of Maxillary Sinus via Canine Fossa

    CPT-31237-NASAL-ENDOSCOPY-BIOPSY-POLYPECTOMY-DEBRIDEMENT

    CPT 31237: Nasal/Sinus Endoscopy with Biopsy or Polypectomy

    CPT-31238-ENDOSCOPIC-NASAL-HEMOSTASIS

    CPT 31238: Endoscopic Nasal Cautery for Control of Bleeding

    CPT-31239-DACRYOCYSTORHINOSTOMY-EXTERNAL-DCR

    CPT 31239: Dacryocystorhinostomy (External DCR)

    CPT-31240-ENDOSCOPIC-CONCHA-BULLOSA-REMOVAL

    CPT 31240: Endoscopic-Assisted Concha Bullosa Removal

    CPT-31241-ENDOSCOPIC-SPHENOPALATINE-ARTERY-LIGATION-NASAL

    CPT 31241: Endoscopic Ligation of Sphenopalatine Artery

    CPT-31242-POSTERIOR-NASAL-NERVE-RADIOFREQUENCY-ABLATION-ENDOSCOPIC

    CPT 31242: Endoscopic Posterior Nasal Nerve Radiofrequency Ablation

    CPT-31243-POSTERIOR-NASAL-NERVE-CRYOABLATION-ENDOSCOPIC

    CPT 31243: Endoscopic Posterior Nasal Nerve Cryoablation

    CPT-31253-ETHMOID-EXCISION-WITH-FRONTAL-SINUS-EXPLORATION

    CPT 31253: Complete Ethmoid Excision with Frontal Sinus Exploration

    Showing 1–10 of 28

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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