# Nasal Polyp Removal: Cost, Coverage, and What to Expect

Source: https://ourhealthnetwork.com/procedure-costs/nasal-polyp-removal
Last reviewed: 2026-04-19
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays about $293 for the surgeon fee on nasal polyp removal, but the all-in bill with facility, anesthesia, and commercial insurance markups typically runs $3,500 to $12,000 depending on whether it's done in-office or at a surgery center.

## What it is

Nasal polyp and growth removal is a surgical procedure that takes soft, non-cancerous swellings out of the nasal passages or sinuses. Polyps are tear-drop shaped tissue that form when the nose lining gets chronically inflamed, usually from long-running allergies, asthma, or sinus infections. They block airflow, dull your sense of smell, and keep sinus pressure from draining properly. Removal restores breathing and lets topical medications actually reach the tissue.

- **Surgery time:** 30 to 90 minutes depending on polyp size and location
- **Anesthesia:** Local with sedation for small in-office cases; general anesthesia in an OR for larger or recurrent disease
- **Hospital stay:** None. This is outpatient. You go home the same day
- **Incision:** None on the outside. Instruments go through the nostrils
- **Visualization:** An endoscope (thin camera) is usually threaded into the nose so the surgeon can see what they're removing

The Medicare data covers two distinct approaches. Endoscopic polyp removal (code 31237) is the common, less invasive version and makes up about 80% of volume. Open removal through the nose (code 30117) is used for larger or more complex growths that need more thorough dissection. Which one you need depends on what your imaging shows, and that directly changes your bill.

## When it is done

Nasal polyps are not dangerous by themselves, but they cause real quality-of-life problems. Surgery becomes the right answer when medications have been tried and failed, or when the polyps are physically blocking your airway. Most ENTs exhaust steroid sprays, oral steroids, and sometimes biologic drugs like Dupixent before recommending the OR.

1. You've had nasal blockage or congestion for 12+ weeks that doesn't respond to steroid sprays
2. Your sense of smell (and often taste) has significantly dropped or disappeared
3. Imaging (usually a CT scan) shows polyps filling the nasal cavity or sinuses
4. You're getting repeat sinus infections because polyps are blocking drainage
5. A single large growth needs to be biopsied to rule out anything worrying
6. Polyps have come back after a previous surgery and are symptomatic again

Alternatives include continuing aggressive medical management, biologic injections for severe asthma-associated polyps (Dupixent, Xolair, Nucala), and SINUVA drug-eluting implants. Biologics work for many patients but cost $30,000+ per year. Surgery is usually cheaper over a multi-year horizon if medications alone can't control the disease.

## What you pay

The Medicare numbers you see in our data, roughly $250 to $460, only cover the surgeon's professional fee. They are not the bill. The full bill includes the facility, anesthesia, and any pathology if tissue is sent for review. That's where sticker shock happens, especially with commercial insurance.

Commercial insurance typically pays 2x to 4x what Medicare pays for the same surgeon work, and facility charges on commercial plans are often even more lopsided.

**If you're on Medicare:**

- Part B covers the surgeon and anesthesia at 80% after your annual deductible ($257 in 2025 figure)
- If done as hospital outpatient, Part B also covers the facility fee at 80%
- If done in-office, there is no separate facility fee
- A Medigap or Medicare Advantage plan typically covers the remaining 20% coinsurance

**If you have commercial insurance:**

- Expect to hit your full deductible ($1,500 to $5,000+ for most plans)
- After deductible, coinsurance is typically 10% to 30% until you reach your out-of-pocket maximum
- The out-of-pocket max caps what you can be billed in a calendar year, often $6,000 to $9,000 for an individual on ACA plans
- Prior authorization is commonly required, especially for endoscopic sinus surgery combined with polyp removal

**If you're uninsured or paying cash:**

- Ambulatory surgery centers often quote bundled cash-pay prices in the $3,500 to $7,500 range that include facility, surgeon, and anesthesia
- In-office polypectomy under local can be quoted at $800 to $2,000 cash-pay, though not every patient is a candidate
- Hospital-based cash-pay is usually the most expensive path and often negotiable downward
- Ask about financial-assistance programs at nonprofit hospitals before scheduling

## Anatomy of the bill

A single nasal polyp surgery usually generates three to five separate bills, and they don't arrive at the same time. Understanding which party bills for what makes it easier to spot errors and negotiate.

**Surgeon fee:** The ENT's professional charge for performing the procedure. Medicare pays $253 for endoscopic (31237) and $460 for open (30117). Commercial plans typically pay 2x to 3x these rates.

**Facility fee:** The biggest line item when not done in-office. A hospital outpatient department can charge $5,000 to $10,000+; an ambulatory surgery center typically charges $1,500 to $4,000. In-office procedures eliminate this fee entirely.

**Anesthesia:** Billed separately by the anesthesiologist or CRNA. General anesthesia typically runs $600 to $2,000 on commercial plans. Local-only cases don't generate an anesthesia bill.

**Pathology:** Removed tissue is almost always sent to pathology to confirm it's benign polyp tissue and not something else. Pathology bills separately, usually $100 to $400 per specimen.

**Pre-op imaging:** A sinus CT is standard before surgery and comes with its own bill, typically $300 to $1,500 depending on whether you go to a hospital or freestanding imaging center.

**Post-op debridement visits:** After endoscopic sinus/polyp surgery, your ENT may do 2 to 4 in-office cleanings over the following month. Each is a separate billable office visit.

## Cost by state

State averages reflect surgeon fees only, since that's what Medicare physician data captures. Among high-volume states where the numbers are statistically meaningful, Alabama ($242), Tennessee ($248), and North Carolina ($251) sit on the low end, while Texas ($328), New York ($327), Wisconsin ($324), and Colorado ($314) run highest. Florida leads in volume with 23,147 services.

The extreme ends of the list (Vermont at $113, Rhode Island at $470) are statistical noise. Vermont had 14 services from 1 provider; Rhode Island had 31 from 2 providers. Small sample sizes produce wild averages.

- **Medicare GPCI:** Medicare adjusts physician fees by locality, so a metro area like NYC pays more per procedure than rural Alabama
- **Commercial negotiation leverage:** Dominant hospital systems in less competitive markets often negotiate much higher commercial rates
- **Cost of living:** Malpractice insurance, staffing, and facility overhead all flow through to charges
- **State surprise-billing laws:** States with stronger protections (NY, CA, TX) limit out-of-network balance bills, though they don't lower base prices

## Office vs facility

For nasal polyp removal, the biggest cost lever you control is whether the procedure happens in the office or in an OR. Medicare data shows 57,052 services done in-office versus 5,603 in a facility, so in-office is actually the dominant setting, at least for the endoscopic variant.

Interestingly, Medicare pays the surgeon slightly more for office-based work ($299) than facility-based work ($184), because in-office the surgeon absorbs all the practice costs (suction, scope, staff). Facility cases are cheaper on the surgeon line, but the facility generates its own large bill that office cases don't.

- **When in-office makes sense:** Small to moderate polyps, patient can tolerate local anesthesia with sedation, no complex sinus anatomy, significant cost savings for commercial or cash-pay patients
- **When ambulatory surgery center makes sense:** Larger polyp burden, patient anxiety or airway concerns, combined with full sinus surgery, when general anesthesia is preferred
- **When hospital outpatient makes sense:** Significant comorbidities (heart disease, bleeding disorders), revision surgery with altered anatomy, combined with other complex procedures

## Who performs the procedure

Nasal polyp removal is overwhelmingly an ENT procedure. Otolaryngologists perform more than 97% of the volume in Medicare data, with 1,101 providers billing 117,981 services. Physician assistants account for a small share (43 providers, usually billing as part of an ENT practice team).

- **Volume:** An ENT who does at least 50+ polyp or sinus cases per year is substantially more experienced than one who does a handful
- **Rhinology focus:** Some ENTs do a fellowship year in rhinology (nose and sinus). For recurrent or complex disease, that extra year matters
- **Endoscopic proficiency:** Ask how often they use image guidance (IGS) for sinus cases. Standard for complex anatomy
- **Board certification:** American Board of Otolaryngology certification is the baseline
- **Second opinion:** If a surgeon recommends surgery at your first visit without a trial of medical therapy, get a second opinion
- **Revision experience:** If you've had polyp surgery before, specifically ask about revision case volume

General surgeons, dermatologists, and primary-care physicians do not perform this procedure. If you see a recommendation from a non-ENT, treat it as a referral suggestion, not the surgeon's own offer to operate.

## How to shop for the best price

Nasal polyp surgery is a procedure where the same 45 minutes of work can produce a $1,500 bill or a $12,000 bill depending on where you do it and who's on the bill.

1. **Request a Good Faith Estimate.** Federal law (No Surprises Act) requires providers to give uninsured or self-pay patients a written estimate of the expected charges before scheduled care. Ask for it in writing and keep it.
2. **Verify every billing party is in-network.** The surgeon, the facility, the anesthesiologist, and the pathologist can each bill separately. An in-network surgeon at an out-of-network ambulatory surgery center is a common surprise-bill trap.
3. **Compare in-office, ASC, and hospital outpatient.** Ask your surgeon if an in-office polypectomy or an ambulatory surgery center is clinically appropriate for your case. The cost difference is often 3x to 5x.
4. **Ask about global-period bundling.** Polyp surgery typically carries a 10-day or 90-day global period, meaning post-op visits are included in the surgeon fee. Any in-office debridement done inside the global period should not generate a separate surgeon bill.
5. **Use payment plans and charity care.** Most nonprofit hospitals have financial-assistance policies that cut bills significantly for patients under certain income thresholds. Ask before you schedule, not after.
6. **Get a second opinion on timing.** If your symptoms haven't been tried against a full 3-month course of topical steroids and nasal rinses, a second ENT may recommend medical therapy first, saving the cost entirely.
7. **Confirm imaging guidance need.** Image-guided surgery (IGS) adds to the bill. It's appropriate for complex anatomy or revision cases but not always necessary for straightforward polypectomy.

Red flags to watch for: estimates that don't itemize surgeon, facility, and anesthesia separately; surgeons who won't quote a range; scheduling coordinators who can't confirm in-network status of the anesthesia group. Vague answers tend to become large bills.

## Surprise billing risks

Nasal polyp surgery has a few specific places where bills blow up unexpectedly. The two most common are out-of-network anesthesia and pathology. Even if you confirm the surgeon and facility are in your network, the anesthesia group that staffs the OR and the pathology lab that reads your tissue may not be.

- **Out-of-network anesthesiologist or CRNA:** Independent anesthesia groups are frequently not in the same network as the facility
- **Pathology:** The lab that examines removed tissue often bills separately and independently
- **Image-guided surgery add-ons:** If IGS equipment is billed as a separate line, confirm coverage in advance
- **Post-op debridement interpreted as new visits:** Should be included in the 10 or 90-day global period, but sometimes billed incorrectly
- **Implant billing for SINUVA or packing:** Some drug-eluting sinus implants generate a separate device bill in the thousands

- **Don't pay until you've verified.** Request an itemized bill and an explanation of benefits (EOB) from your insurer
- **Check No Surprises Act protection.** The 2022 federal No Surprises Act protects you from balance-billing by out-of-network providers at in-network facilities for most situations. File a complaint at cms.gov/nosurprises
- **Request an internal review with your insurer** if your plan denied coverage you believe should apply
- **Contact your state insurance commissioner** if the dispute isn't resolved

## Total recovery cost

Recovery from nasal polyp removal is usually manageable. Most patients are back to desk work within 3 to 7 days and can resume light exercise in 2 weeks. Nasal congestion, crusting, and mild bloody drainage are normal for the first couple of weeks as the lining heals. You'll be told to avoid nose-blowing, heavy lifting, and air travel for a short window.

- **Post-op office visits and debridements:** 2 to 4 visits, often bundled in the global period, but out-of-pocket if your plan bills a facility fee. Budget $100 to $400 total
- **Saline rinses and nasal sprays:** $30 to $80 for a few months of supplies
- **Topical steroid sprays (Flonase, Nasacort):** OTC, about $20/month
- **Oral antibiotics or steroids:** $10 to $60 with insurance
- **Pain medication:** Most patients use Tylenol only. Rx if needed, typically $10 to $30
- **Time off work:** 3 to 7 days, often covered under short-term disability for longer cases
- **Pre-op sinus CT scan:** $300 to $1,500 depending on site of service

Once you add pre-op imaging, pathology, post-op supplies, and lost wages to the procedure cost, the realistic all-in episode budget runs 15% to 25% higher than the sticker price your surgeon quotes. A $6,000 commercial bill becomes a $7,000 to $7,500 episode. Factor that in before you compare quotes.

## Variants of this procedure

- Open Nasal Growth Removal
- Endoscopic Polyp Removal

## Frequently asked questions

### How much does nasal polyp surgery cost with insurance?

With commercial insurance, expect an out-of-pocket cost between $800 and $3,500 depending on your deductible and coinsurance. Plans usually cover the procedure once polyps are symptomatic and medical therapy has been tried. You'll typically hit most of your deductible before the day is over, so the timing in your plan year matters.

### Does Medicare cover nasal polyp removal?

Yes. Medicare Part B covers medically necessary polyp removal performed by an ENT. You're responsible for the annual Part B deductible ($257 in 2025 figure) and 20% coinsurance, unless you have Medigap or Medicare Advantage that picks up those costs. Pre-authorization isn't typically required under traditional Medicare.

### How long is recovery?

Most patients take 3 to 7 days off work for desk jobs, and 7 to 14 days for physical labor. You'll be told to avoid nose-blowing, heavy lifting, swimming, and air travel for about 2 weeks. Nasal congestion and crusting are normal during the first couple of weeks as the lining heals.

### Is this outpatient or does it require a hospital stay?

It's outpatient in essentially all cases. You go home the same day, usually within 1 to 2 hours of the procedure ending. Many small polypectomies are even done in the ENT's office under local anesthesia with no surgery center visit at all.

### What's the difference between the two variants?

Code 31237 is endoscopic removal, meaning a small camera scope guides the surgery. It's the modern default for most polyps. Code 30117 is open removal through the nose, used for larger or more complex growths that need more dissection. The open approach pays more on Medicare (~$460 vs $253) because it's more complex work.

### How do I avoid a surprise bill?

Confirm in-network status in writing for the surgeon, the facility, the anesthesia group, and the pathologist before surgery. Request a Good Faith Estimate. If a surprise bill arrives anyway, don't pay until you've verified it; the 2022 No Surprises Act protects you from balance-billing by out-of-network providers at in-network facilities in most situations.

### What's the cheapest way to get this procedure?

For straightforward cases, an in-office endoscopic polypectomy under local anesthesia is usually cheapest, often $800 to $2,000 cash-pay. For cases that need general anesthesia, an ambulatory surgery center is substantially cheaper than a hospital outpatient department, often by $3,000 to $6,000 on the facility fee alone.

### Where does this cost data come from?

Medicare payment figures come from CMS public physician payment data covering 62,655 services billed in a recent year. Commercial and cash-pay ranges are estimated from published benchmarks and typical commercial-to-Medicare payment ratios. Always confirm your specific cost with your insurer and providers before scheduling.

## Related

- [All procedure cost concepts](https://ourhealthnetwork.com/procedure-costs)
- [Find specialists who perform this procedure](https://ourhealthnetwork.com/find-doctors)
- [Insurance plans that cover this procedure](https://ourhealthnetwork.com/tools/insurance-matcher)