What is a CPT code and why is it important for understanding medical costs?

CPT (Current Procedural Terminology) codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because they provide a universal language for billing, allowing patients and payers to identify specific procedures and determine their associated fees.

How can I find out the cost of a medical procedure using a CPT code?

To find out the cost of a medical procedure using a CPT code, you'll often need to consult specialized tools or contact providers directly. For a reliable estimate tailored to your specific situation and location, you can use platforms like Payerprice. Payerprice offers a fee schedule lookup tool where you can search by CPT code and location to get detailed pricing information.

Why should I use Payerprice instead of CMS for looking up fee schedules?

While CMS (Centers for Medicare & Medicaid Services) provides fee schedules primarily for Medicare services, Payerprice offers a broader and more tailored solution for general users looking up medical costs. Payerprice's fee schedule lookup tool allows users to search with CPT codes and specific locations, often providing commercial payer rates which can be more relevant for individuals covered by private insurance plans or those seeking self-pay options. This makes Payerprice a more versatile resource for understanding various healthcare costs beyond just Medicare.

What kind of information does a fee schedule lookup tool like Payerprice provide?

A fee schedule lookup tool like Payerprice typically provides estimated costs for medical procedures based on CPT codes and geographic location. This information can include the average or range of prices charged by various payers or providers, helping users understand potential out-of-pocket expenses, compare costs between different facilities, and make informed healthcare decisions. The data aims to give transparency into medical service pricing.

CPT 31231 Fee Schedule

Last Verified: October 2026

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.

Nasal Endoscopy Diagnos Unilat Or Bilate (Sepa Proc, Nasal Endoscopy Diagnostic Unilateral Or Bilateral (Separate Procedu

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
Medicare Fee Schedule	View Medicare rates for 31231
Medicaid Fee Schedule	View Medicaid rates for 31231

National average reimbursement for CPT 31231 by major payers:

$210.16

$248.18

$276.19

$132.15

Compare published rates across providers.

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CPT 31231

5 of 25 sample ratesHigher to lower in this preview

Odette Thomas
New York University
NYHospitalist PhysicianNPI 1235385576Tax ID 13-5562308
$962.04Published rate
Helen Leszczynska
Atlantic Health System Inc
NJPediatrics PhysicianNPI 1699237453Tax ID 20-2088165
$436.55Published rate
Michele Cournan
Sunnyview Hospital And Rehabilitation Center
NYNurse PractitionerNPI 1639174626Tax ID 14-1338386
$270.51Published rate
Rengaswamy Asokan
NJInternal Medicine PhysicianNPI 1639196256Tax ID 22-3018787
$173.15Published rate
Pang Lam
Westchester Medical Center Advanced Physician Services, P.C
NYCritical Care Medicine (Internal Medicine) PhysicianNPI 1639497183Tax ID 26-4709927
$92.69Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

This code appears in 1 published specialty market.

Explore state-level rates by specialty

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 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)
31235-CPT	Moderate	Nsl/Sins Ndsc Dx Sphn Sinusc, Nasal/Sinus Endoscopy Diagnostic; With Sphenoid Sinusoscopy (Via Puncture Of Sphenoidal Face Or Cannulation Of Ostium)
31237-CPT	Moderate	Scope Surgery Of Nose Or Sinus, Nose Or Sinus Surgery Aided By A Scope (Endoscopy). The Procedure May Include Removing A Sample Of Tissue For Testing (Biopsy) Removing Excess Tissue Or Cleaning Out The Area.

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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CPT 31231 Fee Schedule

Odette Thomas

Helen Leszczynska

Michele Cournan

Rengaswamy Asokan

Pang Lam