CPT 31231 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 79 - Unrelated procedure - postop period |
| Complexity Level | Moderate |
National average reimbursement for CPT 31231 by major payers:
$210.16
$248.18
$276.19
$317.38
| 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 31231 | ||||||
United | 31231 | $300.67 | 1861494858 - SHOBHARANI SUNDARAM | 461177336 - ST PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC | NY | Pulmonary Disease Physician (207RP1001X) |
United | 31231 | $424.23 | 1164954244 - PRIYANKA CHOPRA | 232865181 | NY | Hospitalist Physician (208M00000X) |
United | 31231 | $385.63 | 1417990086 - DAVID ARVELADZE | 141348692 - (NY) ST PETERS HOSPITAL | NJ | Hospitalist Physician (208M00000X) |
United | 31231 | $175.00 | 1285083477 - GEORGIA INTERVENTIONAL PAIN | 810948119 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31231 | $375.35 | 1851497341 - SANJEEV JAIN | 112419534 - (NY) NORTH SHORE HEMATOLOGY-ONCOLOGY ASSOCIATES, P.C. | NY | Hematology & Oncology Physician (207RH0003X) |
United | 31231 | $92.69 | 1639497183 - PANG LAM | 264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C | NY | Critical Care Medicine (Internal Medicine) Physician (207RC0200X) |
United | 31231 | $197.77 | 1700838620 - KETAN DAVAE | 461032479 - (LA) PONTCHARTRAIN DIAGNOSTIC IMAGING, LLC | MN | Diagnostic Radiology Physician (2085R0202X) |
United | 31231 | $300.67 | 1457639312 - ACHUTA GUDDATI | 141348692 - (NY) ST PETERS HOSPITAL | NY | Hematology & Oncology Physician (207RH0003X) |
United | 31231 | $255.53 | 1255883310 - SHANNON LAVIS | 141348692 - (NY) ST PETERS HOSPITAL | NY | Physician Assistant (363A00000X) |
United | 31231 | $333.89 | 1386626182 - ANGELIA HILL | 863284696 - OU HEALTH PARTNERS INC | NY | Certified Registered Nurse Anesthetist (367500000X) |
United | 31231 | $201.00 | 1689003766 - CANYON VIEW ASC, LLC, CANYON VIEW ASC | 455352976 - (CO) CANYON VIEW ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31231 | $187.00 | 1083711568 - NATRAJ SURGERY CENTER INC. | 201290128 - (CA) NATRAJ SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31231 | $433.85 | 1962460402 - CAROLYN LAFLEUR | 161450921 | NY | Anesthesiology Physician (207L00000X) |
United | 31231 | $448.26 | 1730198706 - ROBERT DROPKIN | 141338310 - ALBANY MEDICAL COLLEGE | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 31231 | $90.00 | 1265438303 - EYE SURGERY CENTER OF CHATTANOOGA, LLC | 200149350 - (TN) EYE SURGERY CENTER OF CHATTANOOGA LLC | TN | 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 31231 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31231 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 31231 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 |
|---|---|---|
| 31231-CPT | Moderate | Nasal Endoscopy Diagnostic Unilateral Bilateral |
| 31233-CPT | Moderate | Nasal/Sinus Endoscopy Diagnostic; With Maxillary Sinusoscopy (Via Inferior Meatus Or Canine Fossa Puncture) (Desc Rvsd 1/1/20) |
| 31235-CPT | Moderate | Nasal/Sinus Endoscopy Diagnostic; With Sphenoid Sinusoscopy (Via Puncture Of Sphenoidal Face Or Cannulation Of Ostium) (Desc Rvsd 1/1/20) |
| 31237-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31231. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31231 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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