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See a sample rate comparisonCPT 31235 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.
Nsl/Sins Ndsc Dx Sphn Sinusc, Nasal/Sinus Endoscopy Diagnostic; With Sphenoid Sinusoscopy (Via Puncture Of Sphenoidal Face Or Cannulation Of Ostium)
| 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 |
| Medicare Fee Schedule | View Medicare rates for 31235 |
| Medicaid Fee Schedule | View Medicaid rates for 31235 |
National average reimbursement for CPT 31235 by major payers:
$365.64
$387.68
$425.40
$284.69
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CPT 31235
5 of 25 sample ratesHigher to lower in this preview
Sjv Management, LLC, South Jersey Vascular Surgery Center
Sjv Management, LLC
$5,127.00Published rateMedstar Surgery Center At Timonium, LLC
Medstar Surgery Center At Timo
$1,316.00Published rateJoliet Surgery Center Limited Partnership, Amsurg Surgery Center
Joliet Surgery Center Limited Partnership
$855.00Published ratePremier Cardiac Surgery Center, PLLC, Premier Cardiac Surgery Center, LLC
Premier Cardiac Surgery Center PLLC
$622.00Published rateDoctors Surgery Center, PA
Doctors Surgery Center PA
$276.00Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 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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