CPT 31240 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 31240 |
National average reimbursement for CPT 31240 by major payers:
$214.19
$213.41
$232.38
$267.28
| 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 31240 | ||||||
United | 31240 | $700.00 | 1457325573 - ST GEORGE ENDOSCOPY CENTER LLC, ST. GEORGE ENDOSCOPY CENTER | 43650097 - (UT) ST GEORGE ENDOSCOPY CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1379.00 | 1962772871 - SURGERY CENTER OF NORTHEAST TEXAS LLC, SURGERY CENTER OF NORTHEAST TEXAS | 454184639 - (TX) SCNETX, LLCDBA SURGERY CENTER | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1190.00 | 1487978789 - CENTER OF MOREHEAD CITY, LLC, THE SURGICAL CENTER OF MOREHEAD CITY | 272095799 - (NC) SURGICAL CENTER OF MOREHEAD | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1389.00 | 1801961313 - PRINCETON EYE GROUP PA, EYE SURGERY PRINCETON | 222361560 - (NJ) PRINCETON EYE GROUP | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $2717.00 | 1205929080 - OAK TREE SURGERY CENTER, LLC | 223524889 - (NJ) OAK TREE SURGERY CENTER, LL, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1410.00 | 1629045133 - MONTICELLO COMMUNITY SURGERY CENTER, LLC, UVA HEALTH SURGICAL CARE RIVERSIDE | 113656095 - (VA) MONTICELLO COMMUNITY SURGERY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $3464.00 | 1891745956 - NORTH SUBURBAN SPINE CENTER LP, NORTH METRO SURGERY CENTER | 571231282 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1778.00 | 1871868422 - PARAMOUNT SURGERY CENTER, LLC, THE CENTER FOR SPECIALIZED SURGERY | 452232749 - (FL) PARAMOUNT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $2307.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $2307.00 | 1871594275 - DESTIN SURGERY CENTER LLC | 593723179 - (FL) DESTIN SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1803.00 | 1972114171 - SURGERY CENTER OF OAKLAND LP | 851685384 - (CA) SURGERY CENTER OF OAKLAND, LP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $713.00 | 1427051796 - SOUTH BEND IN ENDOSCOPY ASC LLC, MICHIANA ENDOSCOPY CENTER | 352011366 - (IN) SOUTH BEND IN ENDOSCOPY ASC LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1696.00 | 1093069452 - UROLOGY SPECIALISTS SURGERY CENTER, LLC | 460876134 - (GA) UROLOGY SPECIALISTS SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $1400.00 | 1821379538 - THE AESTHETIC SURGERY CENTRE, PLLC, CEDAR LASER AND SURGERY CENTER | 900210545 - (WA) AESTHETIC SURGERY CENTRE, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31240 | $2353.00 | 1093772840 - THE SURGERY CENTER AT JENSEN BEACH, LLC | 651198731 - (FL) THE SURGERY CENTER AT JENSEN B | FL | 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 31240 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31240 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 31240 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 |
|---|---|---|
| 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 |
| 31240-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical; W/Biopsy, Polypectomy Or Debridement (Separate Procedure) With Concha Bullosa Resection |
| 31241-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical; With Ligation Of Sphenopalatine Artery |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31240. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31240 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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