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Medicare Physician Fee Schedule · Q3 2026 release

CPT 31231 in Portland, ME 14112-03

Diagnostic nasal endoscopy in ZIPs including 04101, 04102, and 04103

31231 2026 C · Portland, ME flag14112-03 A Active
Allowed amount
$190.05
in a doctor’s own office or clinic

98.3% of the $193.39 national baseline

Medicare payment
$152.04
Patient / secondary
$38.01
Expected total to provider
$190.05

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 31231 in Portland, ME? Copy link

The Medicare allowed amount is $190.05 in the office (non-facility) setting and $52.68 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 1.7% below the national baseline, and the facility amount is 3.8% below the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is Portland, ME in? Copy link

CMS payment locality Southern Maine (14112-03). Every location in it is priced identically.

Why Portland, ME differs from the national amount Copy link

Portland, ME (this locality)
$190.05
National PFS baseline (GPCI 1.000)
$193.39

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Portland, ME at 1.7% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.991
Malpractice GPCI
0.631
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 31231 in Portland, ME: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Portland, ME allowed amount for 31231
Component RVU × GPCI = Adjusted RVU
Work 1.07 1.000 1.0700
Practice expense 4.56 0.991 4.5190
Malpractice 0.16 0.631 0.1010
Sum of adjusted RVUs 5.6899
× $33.4009 2026 conversion factor $190.05

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Portland, ME allows $52.68 for 31231, versus $190.05 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Portland, ME. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 31231 in Portland, ME
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $190.05
Non-participating allowed amount 95% of the participating amount. $180.55
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $207.63
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $152.04
Beneficiary coinsurance The remaining 20%. $38.01
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $3.04
Medicare pays after sequestration Program payment net of the sequestration reduction. $149.00

Contracted rate: % of Medicare in Portland, ME Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $190.05 in the office (non-facility) setting — not the $193.39 national baseline.

Opens the calculator already set to Portland, ME and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Portland, ME rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 96 ZIP codes to this payment locality. 31231 prices identically in every one of them. 1 of them span more than one locality and need ZIP+4 for an exact match.

03901 03902 03903 03904 03905 03906 03907 03908 03909 03910 03911 04001 04002 04003 04004 04005 04006 04007 04009 04011 04013 04014 04015 04017 04019 04020 04021 04024 04027 04028 04029 04030 04032 04033 04034 04038 04039 04040 04042 04043 04046 04047 04048 04049 04050 04053 04054 04055 04056 04057 04061 04062 04063 04064 04066 04069 04070 04071 04072 04073 04074 04075 04076 04077 04078 04079 04082 04083 04084 04085 04087 04090 04091 04092 04093 04094 04095 04096 04097 04098 04101 04102 04103 04104 04105 04106 04107 04108 04109 04110 04112 04116 04122 04123 04124 04260

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

31231 in nearby payment localities Copy link

Payment localities in the same region as Portland, ME, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 31231. Proximity doesn't imply similar pricing — neighbouring localities often differ.

31231 allowed amount in payment localities near Portland, ME
Metro Allowed amount vs. Portland, ME
Boston, MA $223.82 +17.8%
Providence, RI $198.52 +4.5%
Hartford, CT $206.96 +8.9%
New York City, NY $223.48 +17.6%

Every payment locality nationwide is on the CPT 31231 rate map.

Other codes priced in Portland, ME Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Portland, ME
Code Service Portland, ME vs. national
69210 Impacted Earwax Removal $46.67 -2.3%
69436 Ear, nose and throat $140.55 -2.8%
42820 Ear, nose and throat $252.65 -3.1%
99213 Routine Follow-Up Office Visit $93.64 -1.6%
99214 Long Follow-Up Office Visit $133.28 -1.7%
66984 Cataract Surgery $454.10 -1.8%
92014 Full Eye Exam, Returning Patient $126.06 -0.9%
99204 Long New Patient Office Visit $173.66 -2.1%
99212 Brief Follow-Up Office Visit $58.41 -1.7%
99215 Longest Follow-Up Office Visit $188.97 -1.8%
97110 Physical Therapy Exercises $28.81 -0.9%
99203 New Patient Office Visit $115.07 -2.1%

Common questions Copy link

Which ZIP codes does the Portland, ME rate for 31231 cover?
The CMS ZIP-to-locality crosswalk maps 96 ZIP codes to this payment locality, and every one of them prices 31231 identically. Examples include 03901, 03902, 03903, 03904, 03905, 03906. 1 of them span more than one payment locality, so those need ZIP+4 for an exact match.
Why is the 31231 rate in Portland, ME different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices — work 1.000, practice expense 0.991, malpractice 0.631 — scale each RVU component before the conversion factor is applied, which is why Portland, ME allows less than the $193.39 baseline.
What is the facility rate for 31231 in Portland, ME?
$52.68 in a facility, versus $190.05 in the office (non-facility) setting — a $137.37 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 31231 in Portland, ME?
A non-participating provider is paid $180.55 — 95% of the $190.05 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $207.63, which is 115% of the non-participating amount.
How much of the Portland, ME 31231 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($152.04) once the annual Part B deductible is met, and the beneficiary owes 20% ($38.01). Sequestration reduces Medicare's share by about 2% ($3.04), leaving $149.00. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 14112-03's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 3,464)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 58)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 31231 in Portland, ME against the release that governed that date. The last 12 months price without an account; older dates of service need a free account.

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