CPT 31237 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 | • 50 - Bilateral Procedure • None • 79 - Unrelated procedure or service by same physician during postoperative period |
| Complexity Level | Moderate |
National average reimbursement for CPT 31237 by major payers:
$312.98
$359.13
$400.79
$447.32
| 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 31237 | ||||||
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CPT 31237 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31237 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 31237 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 |
|---|---|---|
| 31233 | Moderate | Nasal/Sinus Endoscopy Diagnostic; With Maxillary Sinusoscopy (Via Inferior Meatus Or Canine Fossa Puncture) (Desc Rvsd 1/1/20) |
| 31235 | Moderate | Nasal/Sinus Endoscopy Diagnostic; With Sphenoid Sinusoscopy (Via Puncture Of Sphenoidal Face Or Cannulation Of Ostium) (Desc Rvsd 1/1/20) |
| 31237 | Moderate | Nasal/Sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (Separate Procedure) |
| 31240 | Moderate | Nasal/Sinus Endoscopy, Surgical; W/Biopsy, Polypectomy Or Debridement (Separate Procedure) With Concha Bullosa Resection |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31237. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31237 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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