CPT 31235 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 | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 50 - Bilateral Procedure • UA |
| Complexity Level | Moderate |
National average reimbursement for CPT 31235 by major payers:
$365.64
$387.68
$425.40
$507.22
| 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 31235 | ||||||
United | 31235 | $1608.00 | 1881001758 - ASUCH SURGERY CENTER | 455067682 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $583.00 | 1588785208 - AMBER MEADOWS SURGERY CENTER LLC | 208756114 - (MD) AMBER MEADOWS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $656.00 | 1164093068 - CLEAVER MEDICAL GROUP SURGERY CENTER | 843337139 - (GA) CLEAVER MEDICAL GROUP SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $1213.00 | 1730410697 - SURGICAL SPECIALISTS AT PRINCETON LLC | 270749140 - (NJ) SURGICAL SPECIALISTS AT PRINCE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $276.00 | 1114951365 - DOCTORS SURGERY CENTER, PA | 710718664 - (AR) DOCTORS SURGERY CENTER PA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $1243.00 | 1508965401 - MILLENNIUM SURGERY CENTER INC | 770513445 - (CA) MILLENNIUM SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $415.00 | 1467557678 - BEAN CENTER FOR FOOT SURGERY INC, SIERRA CENTER FOR FOOT SURGERY | 880309955 - (NV) BEAN CENTER FOR FOOT SURGERY INC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $855.00 | 1255397808 - JOLIET SURGERY CENTER LIMITED PARTNERSHIP, AMSURG SURGERY CENTER | 742544709 - (IL) JOLIET SURGERY CENTER LIMITED PARTNERSHIP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $2197.00 | 1831360247 - SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP LLC | 261150611 - (MO) SURGICAL CENTER AT COLUMBIA ORTHOPAEDIC GROUP LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $1476.00 | 1134431323 - BETHESDA CHEVY CHASE SURGERY CENTER, LLC | 272875760 - (MD) BETHESDA CHEVY CHASE SURGERY CEN | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $520.63 | 1164003224 - RACHEL SILLIMAN | 350593390 - DEACONESS HOSPITAL INC | MI | Hospitalist Physician (208M00000X) |
United | 31235 | $511.00 | 1396277208 - ELITE SURGERY CENTER, LLC | 820836081 - (CA) ELITE SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $645.00 | 1083643852 - AMARILLO COLONOSCOPY CENTER LP, PANHANDLE ENDOSCOPY CENTER LP | 202528490 - (TX) AMARILLO COLONOSCOPY CENTER, LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $3994.00 | 1063659605 - HOWARD COMMUNITY SURGERY CENTER LLC | 352118748 - (IN) HOWARD COMMUNITY SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31235 | $437.00 | 1124664198 - ADVANCED SURGICAL CARE EAST LLC | 833657018 - (AZ) ADVANCED SURGICAL CARE EAST LLC | AZ | 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 31235 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31235 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 31235 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 |
|---|---|---|
| 31051-CPT | Moderate | Sinusotomy Sphenoid W Polypectomy |
| 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31235. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31235 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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