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CPT 31040 Fee Schedule

Last Verified: February 2026

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
Medicare Fee ScheduleView Medicare rates for 31040

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$2101.001609400290 - ORTHOPAEDIC ASSOCIATES OF CENTRAL TEXAS SURGERY CENTER, LLC844818321 - (TX) ORTHOPAEDIC ASSOCIATES OF CENTRAL TEXAS SURGERY CENTER LLCTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1362.001336154152 - A CENTER FOR FOOT AND ANKLE SURGERY PA, THE CENTER FOR SPECIAL SURGERY OF HAWTHORNE223284458 - (NJ) A CENTER FOR FOOT AND ANKLE SUNJAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1300.001588994685 - SOUTHEASTERN INTERVENTIONAL PAIN ASC LLC271651377GAAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$5048.001598769481 - MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD, LTD., DOCTORS UNITED SURGERY CENTER752832459 - (TX) MEMORIAL HERMANN SURGERY CENTER PRESTON ROAD LTDTXAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1682.001770075467 - DRY CREEK SURGERY CENTER, LLC825264853 - (CO) DRY CREEK SURGERY CENTER LLCCOAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$848.001306892609 - THE CLEARWATER ORTHOPAEDIC ASC LLC, C MED AMBULATORY SURGERY CENTER331011433 - (FL) THE CLEARWATER ORTHOPAEDIC ASSFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1200.001306079330 - WHITEWATER SURGERY CENTER LLC, WHITEWATER SURGERY CENTER264540954 - (IN) WHITEWATER SURGERY CENTER LLCINAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2353.001972869881 - ADVANCED SURGERY CENTER OF BETHESDA, LLC454376136 - (MD) ASC BETHESDAMDAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$850.001992741300 - LINCOLN ENDOSCOPY CENTER, LLC470807741 - (NE) LINCOLN ENDOSCOPY CENTER LLCNEAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2595.001912909433 - CENTENNIAL SURGUNIT, LLC, CENTENNIAL SURGERY CENTER223580847 - (NJ) CENTENNIAL SURGUNIT LLCNJAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1062.001275536393 - MEDICAL CENTER SURGERY ASSOCIATES, LP621449272 - (FL) MEDICAL CENTER SURGERY ASSOCIATES LPFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$1475.001043391188 - SKIN SURGERY CENTER PS, SKIN SURGERY CENTER911954101 - (WA) SKIN SURGERY CENTER P. S.WAAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2500.001407317019 - RIVERSIDE SURGICAL CENTER OF MEADOWLANDS, LLC, RIVERSIDE SURGICAL CENTER OF RUTHERFORD832735771 - (NJ) RIVERSIDE SURGICAL CENTER OF MEADOWLANDS LLCNJAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$957.001568437820 - FLORIDA ENDOSCOPY AND SURGERY CENTER, LLC, FLORIDA ENDOSCOPY & SURGERY CENTER593622500 - (FL) FLORIDA ENDOSCOPY AND SURGERY CENTER, LLCFLAmbulatory Surgical Clinic/Center (261QA1903X)
United
31040$2859.001104298009 - RED CEDAR SURGERY CENTER, LLC, RED CEDAR SURGERY CENTER, PLLC472947364 - (MI) RED CEDAR SURGERY CENTER, PLLCMIAmbulatory 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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