ENT Billing Cheat Sheet (2026)
ENT billing mixes scopes, surgery, and audiology, and each has its own trap: bilateral procedures billed as one, audiometry billed without the components performed, and cerumen removal billed without instrumentation.
Quick reference for ent billers. Last updated .
Top ENT CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 31231 | Diagnostic nasal endoscopy | $193.39 | $54.78 | 5.79 |
| 31237 | Nasal endoscopy with debridement | $266.54 | $138.28 | 7.98 |
| 31628 | Bronchoscopy with biopsy | $408.49 | $158.65 | 12.23 |
| 30520 | Septoplasty | $613.24 | $613.24 | 18.36 |
| 42820 | Tonsillectomy and adenoidectomy, age under 12 | $260.86 | $260.86 | 7.81 |
| 92557 | Comprehensive audiometry, threshold and speech | $35.74 | $25.72 | 1.07 |
| 92551 | Pure tone audiometry screening | $13.36 | $13.36 | 0.40 |
| 69210 | Removal of impacted cerumen, one or both ears | $47.76 | $27.05 | 1.43 |
| 99213 | Established patient office visit, low MDM | $95.19 | $57.45 | 2.85 |
| 99214 | Established patient office visit, moderate MDM | $135.61 | $84.50 | 4.06 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the ENT billing services page.
Modifiers That Prevent ENT Denials
A bilateral procedure such as bilateral nasal endoscopy where the code is not inherently bilateral and the payer expects modifier 50.
Distinct procedures at separate sites in the same session that NCCI would otherwise bundle.
Increased procedural work, such as an extensive revision sinus surgery, with an operative note quantifying the added effort.
A staged or planned related procedure during a surgical global, such as planned debridement after sinus surgery.
An unrelated procedure by the same surgeon during a global period.
A significant, separately identifiable E/M on the same day as a procedure such as cerumen removal or nasal endoscopy.
Top ENT Denials → Quick Fix
Append modifier 50 on bilateral nasal endoscopy and similar paired procedures. Billed once, it pays half.
69210 requires instrumentation under direct visualization, not lavage by staff. Document the method and impaction. Lavage-only is a different, often non-covered service.
92557 is comprehensive audiometry combining threshold and speech. Document each component performed; billing the comprehensive code without the components is a coding-accuracy denial.
Append modifier 25 and document an evaluation distinct from the decision to perform the scope or cerumen removal.
Post-sinus-surgery debridement during the global uses modifier 58 when staged and planned, with documentation, rather than billing it as unrelated.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 31231 | 0213T | Misuse of Column Two code with Column One code |
| 31231 | 0216T | Misuse of Column Two code with Column One code |
| 31237 | 0213T | Misuse of Column Two code with Column One code |
| 31237 | 0216T | Misuse of Column Two code with Column One code |
| 31628 | 00520 | Anesthesia service included in surgical procedure |
| 31628 | 0213T | Misuse of Column Two code with Column One code |
| 30520 | 0213T | Misuse of Column Two code with Column One code |
| 30520 | 0216T | Misuse of Column Two code with Column One code |
Documentation That Holds Up on Appeal
Diagnostic versus with-debridement, laterality, and the indication, since these change the code and modifier.
Instrumentation under direct visualization, the impaction, and that the provider performed it, not lavage by staff.
Each component performed (threshold and speech) for comprehensive audiometry versus a screening.
Patient age and procedure, since the code set is age-banded.
The global start and whether debridement was staged and planned, supporting modifier 58.
Revenue ENT Practices Leave on the Table
Billing bilateral nasal endoscopy as unilateral and losing half the allowance.
Billing 69210 for lavage rather than the instrument removal it requires, which denies or down-codes.
Billing comprehensive audiometry without documenting the components, instead of the screening code actually performed.
Writing off planned post-sinus-surgery debridement instead of billing it with modifier 58.
ENT Billing FAQ
Does 69210 cover any cerumen removal?
No. 69210 is removal requiring instrumentation under direct visualization performed by the provider. Lavage or irrigation by staff is a different and often non-covered service, so the method has to be documented.
How do I bill bilateral nasal endoscopy?
Append modifier 50 (or RT and LT per payer) when the procedure is performed on both sides and the code is not inherently bilateral. Billed once it pays half.
What does comprehensive audiometry require?
92557 combines threshold and speech audiometry. Document each component performed. If only a screening was done, bill the screening code, not the comprehensive one.
How is post-sinus-surgery debridement billed?
When it is staged and planned within the surgical global, use modifier 58 with documentation. Billing it as an unrelated service or absorbing it both lose revenue.
Stop Losing ENT Revenue to Preventable Denials
Our AAPC-certified ent coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.