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See a sample rate comparisonCPT 31230 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. This Surgery Can Include Removal Of A Portion Of The Bone Around The Eye And Eye Tissue.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Respiratory System |
| Common Place of Service | 21 - Inpatient Hospital 11 - Office |
| Common Modifiers | None LT - Left side of body RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31230 |
| Medicaid Fee Schedule | View Medicaid rates for 31230 |
National average reimbursement for CPT 31230 by major payers:
$2,765.59
$2,631.51
$2,799.33
$3,237.04
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CPT 31230
5 of 25 sample ratesHigher to lower in this preview
Campus Surgery Center LLC
Campus Surgery Center L P
$6,756.00Published rateHarbor Heights Surgery Center, LLC
Harbor Heights Surgery Center LLC
$936.00Published ratePersepolis Group LLC
$740.00Published rateValley Eye Institute Asc LLC, Cvp Surgery Center
Valley Eye Institute Asc LLC
$598.00Published ratePeninsula Eye Center, P.A, Peninsula Cataract & Laser Center
Peninsula Eye Center PA
$388.00Published rate
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See a sample payer proposalCPT 31230 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31230 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 31230 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 |
| 31292-CPT | High | Surgery For Eye Pressure, Surgery Aided By A Scope (Endoscopy) To Relieve Pressure On The Eye. A Small Hole Is Made In The Eye Socket To Give The Eye More Room. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31230. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31230 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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