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See a sample rate comparisonCPT 31090 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 Unilateral Three, Sinusotomy Unilateral Three Or More Paranasal Sinuses(Frontal Maxillary Ethmoid Sphenoid) Sinusotomy Unilateral Three Or More Paranasal Sinuses
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Respiratory System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center |
| Common Modifiers | None 50 - Bilateral Procedure LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31090 |
| Medicaid Fee Schedule | View Medicaid rates for 31090 |
National average reimbursement for CPT 31090 by major payers:
$1,401.46
$1,344.92
$1,462.60
$1,747.83
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CPT 31090
5 of 25 sample ratesHigher to lower in this preview
University Of Kansas Hospital
University Of Kansas Hospital Authority
$6,903.00Published rateJefferson Ambulatory Surgery Center LLC
Jefferson Ambulatory Surgery C
$3,000.00Published rateThe Physicians' North Atlanta Surgery Center LLC
The Physicians North Atlanta Surgery Center LLC
$2,092.00Published rateLincoln Digestive Health Center LLC
$1,743.00Published rateOutpatient Surgical Care Ltd
$833.00Published rate
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See a sample payer proposalCPT 31090 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31090 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 31090 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 |
|---|---|---|
| 31090-CPT | High | Sinusotomy Unilateral Three, Sinusotomy Unilateral Three Or More Paranasal Sinuses(Frontal Maxillary Ethmoid Sphenoid) Sinusotomy Unilateral Three Or More Paranasal Sinuses |
| 31200-CPT | Moderate | Removal Of Sinus Tissue, Surgery To Remove Tissue From The Sinus Between The Eye And Nose (Ethmoid Sinus). The Procedure Is Done To Enable The Sinus To Drain Properly. |
| 31201-CPT | High | Removal Of Sinus Tissue, Surgery To Remove Tissue From The Sinus Between The Eye And Nose (Ethmoid Sinus). The Procedure Is Done To Enable The Sinus To Drain Properly. |
| 31253-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Frontal Sinus Exploration With Removal Of Tissue From Frontal Sinus When Performed Imary Procedure) Tery Disease Data Preparation And Transmission A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31090. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31090 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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