CPT code 31240 – Nasal endoscopy with concha bullosa resection

Key takeaways

CPT code 31240 describes surgical nasal/sinus endoscopy with resection of a concha bullosa, a pneumatized middle turbinate, and differs from the polypectomy code 31237.

NCCI lists 31237 as a column 2 code of 31240 with a modifier indicator of 1. Billing both needs Modifier 59 or XS and distinct-site documentation.

Medicare gives 31240 a 000 global period and a bilateral surgery indicator of 1, so bilateral cases take Modifier 50 and pay at 150%.

In 2026, 31240 carries 2.54 work RVUs and 4.09 total RVUs, for a national unadjusted Medicare payment of about $136.61.

Pabau, the practice management platform we build, submits CPT 31240 claims through Claim.MD, checks eligibility in real time and tracks claim status.

CPT code 31240: official descriptor and procedure overview

The American Medical Association defines CPT code 31240 as Nasal/sinus endoscopy, surgical; with concha bullosa resection. The code belongs to the 31231-31298 nasal/sinus endoscopy family, and every code in it involves placing a rigid or flexible endoscope in the nasal cavity.

A concha bullosa is a pneumatized (air-filled) middle turbinate. When the air cell expands, it can narrow the middle meatus, block sinus drainage, and contribute to recurrent sinusitis or nasal airway obstruction. Resection removes the lateral lamella of the concha bullosa endoscopically, which reopens the middle meatus.

Surgeons often perform the resection during functional endoscopic sinus surgery (FESS). It is separately reportable when removing the concha bullosa is a distinct surgical objective. CPT Assistant notes that 31240 can be bundled into sinus codes such as 31255 when the resection only gives access to the sinuses.

Key clinical facts coders need: The concha bullosa must be documented on preoperative CT imaging. The operative note must specify which turbinate was pneumatized, the laterality, and the technique used. Resection of a non-pneumatized turbinate does not support CPT 31240. Neither does a resection done only to reach the ethmoid or maxillary sinus for another endoscopic code.

How the procedure is performed and what documentation must show

The operative sequence for a concha bullosa resection follows a consistent pattern, and each step maps to documentation requirements auditors look for.

1. Endoscope placement: A rigid nasal endoscope (typically 0- or 30-degree) is introduced into the nasal cavity after mucosal decongestion. Document: scope type, angle, and nasal cavity accessed.
2. Identification of concha bullosa: The enlarged, pneumatized middle turbinate is identified endoscopically and correlated with preoperative CT findings. Document: radiographic confirmation of pneumatization, location (right, left, bilateral).
3. Lateral lamella resection: The lateral aspect of the concha bullosa is incised and removed with scissors, microdebrider, or forceps, leaving the medial lamella intact. Document: instrument used, amount of tissue removed, laterality.
4. Hemostasis and closure: Bleeding is controlled with cautery or packing. Document: hemostatic technique and any packing placed.
5. Post-procedure status: Document that the middle meatus is now patent. Confirm that no additional sinus procedures were performed, or list any that were for multi-code billing.

Medical necessity documentation must establish symptomatic nasal obstruction and a CT-confirmed concha bullosa. It must also show that conservative treatment (nasal steroids, antihistamines) was tried and failed. Payers routinely deny CPT 31240 claims when the operative note lacks the CT correlation or laterality specification.

CPT 31240 vs adjacent sinus endoscopy codes

The 31231-31298 family shares a common base (nasal endoscopy) but diverges by the specific surgical objective. Picking a neighboring code for the wrong objective is an easy way to lose a claim in this family.

CPT 31237 covers biopsy, polyp removal and debridement, while CPT 31240 covers resection of a pneumatized middle turbinate. The targets differ, yet NCCI still pairs the two codes. Check the current CMS NCCI PTP edit tables before submitting any claim that pairs 31240 with 31237.

Bundling rules and NCCI edits for CPT 31240

The National Correct Coding Initiative (NCCI) lists CPT 31237 as a column 2 code of CPT 31240 in the Q4 2026 practitioner table. The edit carries a modifier indicator of 1, so an NCCI-associated modifier can bypass it when the documentation supports a distinct service. Diagnostic endoscopy, CPT 31231, is bundled too, and its indicator of 0 means no modifier can override that edit. The table below shows where each neighboring code stands.

When both 31237 and 31240 are paid, Medicare applies its special endoscopy rule. Both codes carry a multiple procedure indicator of 3 and share the base code 31231. The higher-valued endoscopy pays in full, and the other pays its value minus the 31231 base.

What this means in practice: Say the surgeon resects a concha bullosa and removes a polyp at a different site in the same session. In that case, append Modifier 59 or XS to 31237. The documentation must state that the polypectomy was performed at a separate site from the concha bullosa resection. Without that detail, the 31237 line will deny. CMS updates the NCCI tables every quarter, so recheck the edit each quarter.

Can CPT 31240 be billed with septoplasty (30520) or turbinate surgery (30140)?

Yes, CPT 31240 can be billed with CPT 30520 and CPT 30140 when each procedure is clinically indicated in the same session. The Q4 2026 NCCI practitioner table carries no edit that pairs 31240 with either code. The three procedures treat anatomically distinct structures.

• 30520 with 31240: Report both codes. Add Modifier 51 (Multiple Procedures) to the lower-value code per Medicare guidelines. Document separate clinical indications: deviated septum for 30520, concha bullosa for 31240.
• 30140 with 31240: Similarly separately reportable. The inferior turbinate (30140) and the middle turbinate concha bullosa (31240) are distinct structures. Document each anatomical target independently.
• All three together: Permissible when clinical documentation supports each procedure. Rank by RVU value: highest to lowest. Apply Modifier 51 to the second and third procedures when required by the payer.

Modifiers for CPT code 31240

Correct modifier selection directly affects whether CPT code 31240 claims pay on first submission. The four modifiers ENT billing teams apply most often to this code are described below.

Bilateral billing: using Modifier 50 with CPT 31240

When concha bullosa resection is performed bilaterally, report CPT 31240 once with Modifier 50 appended. The 2026 fee schedule gives 31240 a bilateral surgery indicator of 1. Under that indicator, Medicare pays the bilateral line at 150% of the single-procedure amount (Claims Processing Manual, Chapter 12).

Some commercial payers deviate from this rule and require two line items (31240-RT and 31240-LT) instead of one line with -50. Confirm the payer’s bilateral reporting preference before submission to avoid automatic adjustment to 50% of the second unit. The operative note must document right-side and left-side findings separately and confirm a concha bullosa was present and resected on each side.

CPT code 31240 reimbursement: Medicare rates and RVU values

Medicare reimbursement for CPT code 31240 is calculated from the CMS Physician Fee Schedule. The figures below are CY2026 national unadjusted values from the October 2026 CMS relative value file. Local rates vary through the Geographic Practice Cost Index and change with each annual update. Check your locality in the CMS look-up tool before setting your fee schedule.

Qualifying APM participants use the $33.5675 conversion factor instead, which gives about $137.29. Commercial payers set their own rates by contract. Because CMS lists the non-facility practice expense as NA, an office-based case carries the same 4.09 total RVUs as a facility case. In a hospital outpatient department or ambulatory surgical center, the facility bills its own claim under OPPS or the ASC payment system.

Global period and post-operative care for CPT 31240

CPT 31240 carries a 000 global period in the 2026 Medicare Physician Fee Schedule, the indicator CMS uses for endoscopic and minor procedures. The global package covers only the day of the procedure, so no post-operative window follows it. Post-op care is therefore not bundled into 31240.

What the global package includes: The pre-procedure evaluation and the procedure itself on the date of surgery, plus immediate post-procedure care that day. Follow-up visits on later days, including a packing removal or debridement visit, fall outside the package and are reported on their own.

When a separate E/M is billable: A significant, separately identifiable E/M service on the same day as the procedure is reported with Modifier 25. The note must show work beyond the routine pre-procedure assessment. Modifier 24 does not apply, because it covers an unrelated E/M during a post-operative period, and 31240 has none.

Prior authorization requirements for CPT 31240

Prior authorization is required for CPT 31240 by multiple commercial payers, including Ambetter (confirmed by provider policy documentation). Medicare does not require prior authorization for this procedure. Medicare Advantage plans may impose their own PA requirements, so check the specific plan’s policy rather than assuming standard Medicare rules apply.

The insurance eligibility verification step before scheduling concha bullosa resection should include a PA check alongside the benefits check. A Claim.MD eligibility request returns coverage and benefits in real time, but the PA itself is still requested from the payer.

Common PA clinical criteria for CPT 31240:

• CT of the paranasal sinuses confirming a concha bullosa with middle meatus obstruction
• Documented nasal obstruction symptoms (typically 3+ months duration)
• Failed conservative management: at least one trial of intranasal corticosteroid spray, nasal saline irrigation, or antihistamine therapy
• Documented clinical examination findings (nasal endoscopy or anterior rhinoscopy confirming obstruction)
• Absence of active sinonasal malignancy or contraindication to general/local anesthesia

A missing CT report and undocumented conservative treatment are the two most common reasons authorization is initially denied. Many payers also require the full operative plan. If the surgeon plans septoplasty (30520) or turbinate reduction (30140) in the same session, list every planned code in the PA request.

ICD-10 diagnosis codes that support CPT 31240

Pairing CPT 31240 with an ICD-10-CM code that accurately describes the underlying condition is essential for establishing medical necessity. The diagnosis code must match the clinical indication documented in the operative note and supported by the CT findings.

Common denial reasons for CPT 31240 and how to prevent them

Most CPT code 31240 denials fall into five recurring patterns. A denial management workflow that screens for them before submission saves an appeal later. Our guide to denial codes lists the remittance advice codes that signal each denial type.

Documentation checklist for CPT 31240 claims

Auditors reviewing CPT 31240 claims look for a specific set of operative note elements. An operative note that clearly addresses each item below will support both initial payment and any post-payment audit. Committing to consistent medical billing compliance documentation standards reduces audit exposure across the ENT practice’s full code set.

• Indication: Symptomatic nasal obstruction due to concha bullosa, not responsive to conservative treatment
• Imaging correlation: Date and result of paranasal sinus CT confirming pneumatized middle turbinate
• Laterality: Right, left, or bilateral – explicitly stated, not implied
• Endoscopic technique: Scope angle and type; insertion pathway; visualization of concha bullosa
• Resection details: Instrument used (scissors, microdebrider, forceps); which lamella removed; estimated tissue volume
• Additional procedures: If 30520, 30140, or other sinus codes billed, each must have its own indication and technique description
• Hemostasis: Method and any packing material placed
• Post-operative plan: Follow-up interval, any packing removal scheduled

How practice management software supports accurate CPT 31240 billing

The denials described above start before the claim is built. A missed distinct-site modifier, a lapsed PA or a mis-keyed bilateral line all trace back to scheduling and charge entry.

In Pabau’s claims management software, the codes and modifiers your coder assigns go to payers as electronic CMS-1500 claims through the Claim.MD clearinghouse. Real-time eligibility checks confirm coverage before the resection is booked, which supports submitting a clean claim the first time.

After submission, claim-status tracking shows where each 31240 claim sits, so a rejected bilateral line is caught early. Your team still decides the codes, modifiers and PA requests, and Pabau keeps submission and follow-up in one place.

Reduce claim denials for ENT surgical codes

Pabau submits CPT 31240 claims through Claim.MD, checks eligibility in real time and tracks claim status, so ENT practices spend less time chasing denials.

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Conclusion

CPT 31240 pays about $136.61 nationally in 2026, so one denied line takes most of the case’s professional payment with it. The decisions that protect it happen before surgery. The CT has to confirm the concha bullosa. The surgeon then has to decide whether the resection is its own objective or only access for a sinus code.

The trade-off worth remembering is 31237. Adding it with Modifier 59 or XS raises the claim’s value, but it also invites a closer look at the op note. Bill it only when the polyp site is plainly separate from the turbinate.

A claims workflow that keeps eligibility checks, submission and claim status together makes those rules easier to follow on every ENT case. Book a demo to see how Pabau handles claim submission and tracking for ENT procedures.

Continue your research

Need to understand how clearinghouses process ENT surgical claims? Medical claims clearinghouse guide explains how electronic claim routing works and where 31240 claims can stall in the payer pipeline.

Want to understand ERA remittance codes on denied 31240 claims? Electronic remittance advice explained breaks down how to read 835 files and identify denial reason codes from NCCI or prior auth failures.

Comparing Claim.MD clearinghouse options for your ENT practice? Claim.MD vs Office Ally covers the key differences between US clearinghouses for practices managing high-volume surgical endoscopy claims.

Billing a polypectomy in the same session? CPT code 31237 covers the descriptor, documentation and modifiers for endoscopic biopsy, polypectomy and debridement.

Did the surgeon only scope the nose? CPT code 31231 explains when diagnostic nasal endoscopy is reported on its own.

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