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See a sample rate comparisonCPT 31085 Fee Schedule
Last Verified: October 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.
Sinusotomy Frontal Obliterati, Sinusotomy Frontal Obliterative With Osteoplastic Flapcoronal Incision Sinusotomy Frontal Obliterative With Osteoplastic Flap
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Respiratory System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 51 - Multiple procedures 50 - Bilateral Procedure |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31085 |
| Medicaid Fee Schedule | View Medicaid rates for 31085 |
National average reimbursement for CPT 31085 by major payers:
$1,642.58
$1,664.35
$1,801.74
$2,079.11
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CPT 31085
5 of 25 sample ratesHigher to lower in this preview
West Penn Allegheny Health System Inc., Allegheny General Hospital
Highmark Health
$16,793.65Published rateBrightside Surgical, LLC
Brightside Surgical LLC
$4,247.00Published rateLahaye Center For Advanced Eye Care Of Lafayette, Inc.
$2,043.00Published rateRiverview Surgical Center LLC
Riverview Surgical Center, LLC
$1,372.00Published rateBergen Gastroenterology PC
Bergen Gastroenterology, P.C.
$705.00Published rate
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See a sample payer proposalCPT 31085 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31085 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 31085 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 |
|---|---|---|
| 31085-CPT | High | Sinusotomy Frontal Obliterati, Sinusotomy Frontal Obliterative With Osteoplastic Flapcoronal Incision Sinusotomy Frontal Obliterative With Osteoplastic Flap |
| 31087-CPT | High | Removal Of Sinus Tissue, Surgery To Removed Diseased Tissue From The Frontal Sinus (Between The Eyebrows) And If Necessary From The Ethmoid Sinus (Between The Nose And Eye). An Opening For Drainage To The Nose May Be Created. |
| 31267-CPT | Moderate | Scope Surgery Of Nose Or Sinus, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. The Procedure May Include Draining A Sinus Or Removing Abnormal Tissue Such As Polyps. |
| 31276-CPT | Moderate | Sinus Surgery With Scope, Surgery Aided By A Scope (Endoscopy) To Explore The Sinus In The Forehead. The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy). |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31085. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31085 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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