CPT 31051 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Respiratory System |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • 50 - Bilateral Procedure |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 31051 |
National average reimbursement for CPT 31051 by major payers:
$865.05
$853.59
$918.82
$1,126.77
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 31051 | ||||||
United | 31051 | $826.00 | 1659683662 - PREMIER ENDOSCOPY CENTER, LLC | 272932575 - (AZ) PREMIER ENDOSCOPY CENTER, P.L.L.C. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $1417.00 | 1396828323 - EYE CARE SURGERY CENTER OF MEMPHIS, LLC | 470920340 | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $3000.00 | 1316009194 - ADVOCATE SOUTHWEST AMBULATORY SURGERY CENTER LLC, TINLEY WOODS SURGERY CENTER | 364437931 - (IL) ADVOCATE SOUTHWEST AMBULATORY SURGE | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $3661.00 | 1902472715 - CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC, CARTI SURGERY CENTER | 710437657 - (AR) CENTRAL ARKANSAS RADIATION THERAPY INSTITUTE INC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $3935.00 | 1154911592 - BCC WEST VALLEY LLC | 854264663 - (AZ) BCC WEST VALLEY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $1747.00 | 1477542520 - THE EYE SURGERY CENTER, LTD. | 263915695 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $1773.00 | 1205013273 - GLEN BURNIE MD ENDOSCOPY ASC LLC, ENDOCENTRE AT QUARTERFIELD STATION | 261467098 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $3500.00 | 1316604440 - GEORGIA INTERVENTIONAL PAIN | 862695318 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $7000.00 | 1114975794 - GROSSMONT SURGERY CENTER, L.P. | 330749339 - (CA) GROSSMONT SURGERY CENTER LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $5922.00 | 1821332370 - RIVER VALLEY ASC LLC, RIVER VALLEY ASC, LLC | 460758315 - (CT) RIVER VALLEY ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $5589.00 | 1679943989 - LIVINGSTON ASC LLC | 474735737 - (NJ) LIVINGSTON ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $5433.00 | 1306421268 - COLORADO UROLOGIC SURGERY CENTER, LLC, COLORADO UROLOGIC SURGERY CENTER | 851926897 - (CO) COLORADO UROLOGIC SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $3152.00 | 1851520514 - CAPITOL SURGERY CENTER LLC, WAVERLY LAKE SURGERY CENTER | 270199061 - (OR) CAPITOL SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $4300.00 | 1841255718 - PAOLI SURGERY CENTER LLC | 621547618 - (PA) PAOLI SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31051 | $875.00 | 1407828494 - INDEPENDENCE ASC LLC, THE ENDOSCOPY CENTER - EAST | 621707564 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 31051 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31051 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 31051 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.
| Code | Complexity | Description |
|---|---|---|
| 31050-CPT | Moderate | Sinusotomy, Sphenoid, Withor Without Bi |
| 31051-CPT | Moderate | Sinusotomy Sphenoid W Polypectomy |
| 31287-CPT | Moderate | Incision Of Nasal (Sphenoid) Sinus Using An Endoscope |
| 31288-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical, With Sphenoidotomy; With Removal Of Tissue From The Sphenoid Sinus |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31051. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31051 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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