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See a sample rate comparisonCPT 31086 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.
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.
| 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 RT - Right side of body 59 - Distinct Procedural Service 51 - Multiple procedures |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31086 |
| Medicaid Fee Schedule | View Medicaid rates for 31086 |
National average reimbursement for CPT 31086 by major payers:
$1,617.39
$1,472.87
$1,586.50
$1,876.44
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CPT 31086
5 of 25 sample ratesHigher to lower in this preview
Howard Community Surgery Center LLC
$10,317.00Published rateAnne Arundel-Sca Surgicenter, LLC
Anne Arundelsca Surgicenter LLC
$4,488.00Published ratePersepolis Group LLC
$3,000.00Published rateSt Dominic Ambulatory Surgery Center L L C
$1,485.00Published rateAdvanced Ambulatory Surgery Center, LLC
Advanced Ambulatory Surgery Center LLC
$814.00Published rate
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See a sample payer proposalCPT 31086 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31086 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 31086 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 |
| 31086-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. |
| 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. |
| 31287-CPT | Moderate | Scope Surgery Of Nose Or Sinus, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. The Procedure May Include Draining The Sinus Behind The Eyes (Sphenoid Sinus) Or Removing Abnormal Tissue Such As Polyps. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31086. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31086 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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