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CPT 31040 Fee Schedule

Last Verified: December 2025

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Op Pterygomaxill Fossa Transantral
Key FactDetail
Service Type

Surgery

Surgical Procedures on the Respiratory System

Common Place of Service

21 - Inpatient Hospital

22 - On Campus Outpatient Hospital

Common Modifiers

None

RT - Right side of body

LT - Left side of body

Complexity LevelHigh

National average reimbursement for CPT 31040 by major payers:

bcbs

$1,108.89

uhc

$1,011.52

aetna

$1,102.87

cigna

$1,314.99

Preview provider-level rates for...
For billing codeCPT 31040
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for CPT 31040

United
31040$1189.001033294640 - NORTHERN NEW JERSEY EYE INSTITUTE PA222489176 - (NJ) NORTHERN NEW JERSEY EYE INSTITUTE, P.A.NJAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2965.001326309394 - ADVANCED SURGERY CENTER OF ORLANDO LLC453785008 - (FL) ADVANCED SURGERY CENTER OF ORLANDO LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$900.001215410592 - ALLIANCE SURGERY CENTER AT WOODSTOCK, LLC830957221 - (GA) ALLIANCE SURGERY CENTER AT WOODSTOCK LLCGAAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2689.001679086078 - CYPRESS CREEK OUTPATIENT SURGICAL CENTER, LLC460552249 - (FL) CYPRESS CREEK OUTPATIENT SURGICAL CENTER LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2859.001316641236 - VENTURA ENDOSCOPY CENTER PARTNERS LLC922672667CAAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$920.001972194199 - AMELIA ISLAND SURGERY CENTER LLC861376716 - (FL) AMELIA ISLAND SURGERY CENTER LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1329.001124197165 - MCALLEN SURGICAL SPECIALTY CENTER LTD742952544 - (TX) MCALLEN SURGICAL SPECIALTY CENTERTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$3500.001245798826 - SURGCENTER OF GREATER DALLAS, LLC., SURGCENTER OF GREATER DALLAS831498677 - (TX) SURGCENTER OF GREATER DALLAS LLCTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1587.001922211192 - VOORHEES SURGERY CENTER, LLC651203770 - (NJ) VOORHEES SURGERY CENTER LLCNJAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$775.001649250218 - LORAIN SURGERY CENTER, LLC201641777 - (OH) LORAIN SURGERY CENTER LLCOHAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1011.001225497019 - LANGLEY HOLDINGS, LLC473550370OKAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$791.001346292372 - SURGERY CENTER PARTNERS. LLC, TIMBERLAKE SURGERY CENTER421580803 - (MO) SURGERY CENTER PARTNERS LLCMOAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1564.001912158684 - SURGCENTER OF BEL AIR262215322 - (MD) SURGCENTER OF BEL AIR, LLCMDAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1513.001982677191 - LAS VEGAS EAST OPHTHALMOLOGY ASC LLC, SHEPHERD EYE SURGICENTER752829740NVAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$679.001376789248 - PIONEER AMBULATORY SURGERY CENTER, LLC262749514 - (NC) PIONEER AMBULATORY SURGERY CENTER LLCNCAmbulatory Surgical Clinic/Center (261QA1903X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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CPT 31040 vs. Other Surgical Procedures on the Respiratory System Codes

The CPT 31040 code is part of the Surgery services used for Surgical Procedures on the Respiratory System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 31040 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
31032-CPTModerateSinusotomy Maxilla Radical W/Removal Pol
31040-CPTHighOp Pterygomaxill Fossa Transantral
31200-CPTModerateEthmoidectomy Intranasal Anterior
31201-CPTHighEthmoidectomy Intranasal Total

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31040. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 31040 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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