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See a sample rate comparisonCPT 31225 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 Jaw Bone, Surgery To Remove A Portion Of The Upper Jaw Bone That Is Injured Or Diseased. A Sample May Be Tested To Identify The Disease.
| 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 LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31225 |
| Medicaid Fee Schedule | View Medicaid rates for 31225 |
National average reimbursement for CPT 31225 by major payers:
$2,493.53
$2,364.57
$2,636.20
$2,917.90
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CPT 31225
5 of 25 sample ratesHigher to lower in this preview
Beltway Surgery Centers LLC, Indiana Hand To Shoulder Beltway Surgery Center
$7,400.00Published rateDierdre Payne
Deaconess Hospital Inc
$1,487.66Published rateWest End Surgical, LLC, Oregon Surgical Institute
West End Surgical LLC
$802.00Published rateDigestive Healthcare Of Georgia Endoscopy Center Mountainside
$500.00Published rateForest Canyon Endoscopy & Surgery Ctr PC
Forest Canyon Endoscopy & Surgery Center, PC
$100.00Published rate
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See a sample payer proposalCPT 31225 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31225 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 31225 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 |
|---|---|---|
| 31225-CPT | High | Removal Of Jaw Bone, Surgery To Remove A Portion Of The Upper Jaw Bone That Is Injured Or Diseased. A Sample May Be Tested To Identify The Disease. |
| 31230-CPT | High | Removal Of Jaw Bone, Surgery To Remove A Portion Of The Upper Jaw Bone That Is Injured Or Diseased. A Sample May Be Tested To Identify The Disease. This Surgery Can Include Removal Of A Portion Of The Bone Around The Eye And Eye Tissue. |
| 31231-CPT | Moderate | Nasal Endoscopy Diagnos Unilat Or Bilate (Sepa Proc, Nasal Endoscopy Diagnostic Unilateral Or Bilateral (Separate Procedu |
| 31233-CPT | Moderate | Nsl/Sins Ndsc Dx Max Sinusc, Nasal/Sinus Endoscopy Diagnostic; With Maxillary Sinusoscopy (Via Inferior Meatus Or Canine Fossa Puncture) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31225. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31225 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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