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See a sample rate comparisonCPT 31242 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Treat Nerves At Back Of Nose, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. Radiofrequency Energy Is Used To Treat Nerves At The Back Of The Nose.
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Respiratory System |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31242 |
| Medicaid Fee Schedule | View Medicaid rates for 31242 |
National average reimbursement for CPT 31242 by major payers:
$3,115.54
$3,470.55
$2,920.83
$400.12
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CPT 31242
5 of 25 sample ratesHigher to lower in this preview
Joseph Sniezek
$8,680.75Published rateNathan Osbun
Legacy Good Samaritan Hospital And Medical Center Payroll Dept
$6,411.83Published rateInnovative Sleep Centers, PLLC, Northwest Neurology And Memory Clinic
Innovative Sleep Centers PLLC
$4,805.10Published rateEllensburg Integrative Medicine PLLC
$3,678.91Published rateMarys Corner Medical Clinic Inc Ps, Marys Corner Medical Clinic
Marys Corner Medical Clinic, Inc., P.S.
$231.27Published rate
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See a sample payer proposalCPT 31242 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31242 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 31242 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 |
|---|---|---|
| 31242-CPT | High | Treat Nerves At Back Of Nose, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. Radiofrequency Energy Is Used To Treat Nerves At The Back Of The Nose. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31242. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31242 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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