CPT 31205 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Respiratory System |
| Common Place of Service | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31205 |
National average reimbursement for CPT 31205 by major payers:
$1,276.91
$1,177.57
$1,256.43
$1,538.65
| 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 31205 | ||||||
United | 31205 | $1290.00 | 1336658145 - BROWN UROLOGY, INC., COLLYER STREET OPERATORY | 821512459 - (RI) BROWN UROLOGY INC | RI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $2353.00 | 1104974310 - NORTHWEST SURGERY CENTER, LLP, NORTHWEST SURGERY CENTER | 205537270 - (TX) NORTHWEST SURGERY CENTER LLP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $675.00 | 1689657058 - CENTER FOR ADVANCED EYE SURGERY, LTD | 341866635 - (OH) CENTER FOR ADVANCED EYE SURGERY LTD | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $2388.00 | 1588854772 - ALABAMA DIGESTIVE HEALTH ENDOSCOPY CENTER, LLC | 201243484 - (AL) ALABAMA DIGESTIVE HEALTH | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $614.00 | 1184675704 - DOCTORS SURGERY CENTER LLC | 593518740 - (FL) DOCTORS SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $1155.00 | 1720081664 - HEATON LASER AND SURGERY CENTER L L C | 752752100 - (TX) HEATON LASER AND SURGERY CENTER L L C | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $630.00 | 1285767822 - ARIZONA SURGICAL SPECIALISTS CENTER, LLC | 760737449 - (AZ) ARIZONA SURGICAL SPECIALISTS CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $525.00 | 1295824100 - BETTER LIVING ENDOSCOPY CENTER | 640877920 - (MS) BETTER LIVING ENDOSCOPY CENTER | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $1739.00 | 1013298926 - MATTHEWS SURGERY CENTER, LLC | 273634811 - (NC) MATTHEWS SURGERY CENTER LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $1624.18 | 1114159514 - BILAL HIJAZI | 350593390 - DEACONESS HOSPITAL INC | TN | Emergency Medicine Physician (207P00000X) |
United | 31205 | $700.00 | 1083654636 - PLASTIC SURGERY SPECIALISTS, PC, NORTH ARUNDEL PLASTIC SURGERY SPECIALISTS | 521357688 - (MD) PLASTIC SURGERY SPECIALISTS, P.C. | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $4895.00 | 1740236454 - PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT LLC, PRINCESS ANNE AMBULATORY SURGERY CENTER | 204920880 - (VA) PRINCESS ANNE AMBULATORY SURGERY MANAGEMENT, LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $734.00 | 1346308962 - PODIATRY ASSOCIATES AMBULATORY SURGICAL CENTERS LLC | 522210174 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $5048.00 | 1124492541 - MEMORIAL HERMANN SURGERY CENTER PINECROFT, LLC | 371796296 - (TX) MEMORIAL HERMANN SURGERY CENTER PINECROFT LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31205 | $1250.00 | 1023043445 - AESTHETIC EYE ASSOCIATES, PS, ALLURE LASER CENTER & MEDISPA | 911577091 | WA | 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 31205 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31205 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 31205 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 |
|---|---|---|
| 31200-CPT | Moderate | Ethmoidectomy Intranasal Anterior |
| 31201-CPT | High | Ethmoidectomy Intranasal Total |
| 31205-CPT | High | Ethmoidectomy Extranasal Total |
| 31253-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical With Ethmoidectomy; Total (Anterior And Posterior), Including Frontal Sinus Exploration, With Removal Of Tissue From Frontal Sinus, When Performed |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31205. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31205 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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