CPT 31238 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 31238 |
National average reimbursement for CPT 31238 by major payers:
$347.13
$361.39
$392.40
$442.21
| 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 31238 | ||||||
United | 31238 | $610.00 | 1093726796 - ROCKY MOUNTAIN EYE SURGERY CENTER INC | 810493712 - (MT) ROCKY MOUNTAIN EYE SURGERY CENTER INC | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $1530.00 | 1659953636 - VCU HEALTH AMBULATORY SURGERY CENTER, LLC | 863310585 - (VA) VCU HEALTH AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $1233.00 | 1891253035 - ADVANCED CENTER FOR SURGERY, THE ADVANCED CENTER FOR SURGERY | 611917634 - (FL) ADVANCED CENTER FOR SURGERY | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $916.00 | 1043391188 - SKIN SURGERY CENTER PS, SKIN SURGERY CENTER | 911954101 - (WA) SKIN SURGERY CENTER P. S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $1028.00 | 1538189907 - INDEPENDENT PRACTIONERS OF AMERICA, LLC | 450455462 - (ND) INDEPENDENT PRACTITIONERS OF AMERICA, LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $832.00 | 1720667637 - PCAC GI JV LLC | 850878312 - (IL) PCAC GI JV LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $663.00 | 1952917445 - AURORA SURGICAL CENTER LLC | 852607513 - (AZ) AURORA SURGICAL CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $1258.00 | 1346383155 - BRIARCLIFF AMBULATORY SURGERY CENTER LP, BRIARCLIFF SURGERY CENTER | 202852584 - (MO) BRIARCLIFF AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $1776.00 | 1790752061 - NORTH FLORIDA REGIONAL FREESTANDING SURGERY CENTER LP | 621460781 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $1114.00 | 1912460015 - PREMIER EYE SURGERY CENTER OF COLORADO, LLC, PREMIER EYE SURGERY CENTER | 823760640 - (CO) PREMIER EYE SURGERY CENTER OF COLORADO, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $625.00 | 1609983477 - NORTH GEORGIA ENDOSCOPY CENTER INC | 582070246 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $525.00 | 1477572675 - MOOTHEDATH A MENON, WIKA ENDOSCOPY CENTER | 363164643 - (CA) M.A. MENON, M.D. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $525.00 | 1356305916 - THE ROME ENDOSCOPY CENTER | 581866240 - (GA) THE ROME ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $7690.00 | 1649931072 - MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS, LLC, MEDICAL CITY ORTHOPEDIC & SPINE SURGERY CENTER DALLAS | 842824507 - (TX) MEDICAL CITY SPECIALTY SURGICENTER OF DALLAS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31238 | $614.00 | 1720514359 - JOHNS HOPKINS SURGERY CENTERS SERIES, KNOLL NORTH SURGERY CENTER | 208707724 - (MD) JOHNS HOPKINS SURGERY CENTER SERIES | MD | 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 31238 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31238 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 31238 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) |
| 31237-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical; With Biopsy, Polypectomy Or Debridement (Separate Procedure) |
| 31238-CPT | Moderate | Nasal Sinus Endoscopy Surgical With Biopsy Polypectomy W Control Epist |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31238. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31238 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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