CPT 31242 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 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 31242 |
National average reimbursement for CPT 31242 by major payers:
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| 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 31242 | ||||||
United | 31242 | $6347.27 | 1912158023 - PROVIDENCE HEALTH & SERVICES, PMG NW WA RECONSTRUCTIVE & PLASTIC SURGERY | 320261234 | WA | Multi-Specialty Group (193200000X) |
United | 31242 | $8680.75 | 1518943646 - JOSEPH SNIEZEK | 912073120 | WA | Otolaryngology Physician (207Y00000X) |
United | 31242 | $350.30 | 1932552353 - ENRIQUE GORBEA DOLAGARAY | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Plastic Surgery within the Head & Neck (Otolaryngology) Physician (207YX0007X) |
United | 31242 | $5572.45 | 1316309321 - HARRISON CASH | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Plastic Surgery within the Head & Neck (Otolaryngology) Physician (207YX0007X) |
United | 31242 | $3678.91 | 1124166244 - MICHAEL NOONAN | 853316235 - (WA) AMG OF WASHINGTON PC | OR | Allergy & Immunology Physician (207K00000X) |
United | 31242 | $6411.83 | 1548535784 - NATHAN OSBUN | 930386793 - LEGACY GOOD SAMARITAN HOSPITAL AND MEDICAL CENTER PAYROLL DEPT | WA | Urology Physician (208800000X) |
United | 31242 | $6077.72 | 1386602555 - FRANCISCAN MEDICAL GROUP, FRANCISCAN MEDICAL CLINIC-GIG HARBOR | 911939739 - FRANCISCAN MEDICAL GROUP | WA | Multi-Specialty Group (193200000X) |
United | 31242 | $8264.79 | 1902121254 - MAAHUM HAIDER | 912073120 | WA | Urology Physician (208800000X) |
United | 31242 | $5572.45 | 1356573372 - IAN HUMPHREYS | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Otolaryngology Physician (207Y00000X) |
United | 31242 | $4204.47 | 1841274412 - KARNY JACOBY | 273331851 - (WA) WASHINGTON UROLOGY ASSOCIATES, PLLC | WA | Urology Physician (208800000X) |
United | 31242 | $3678.91 | 1649853367 - ELLENSBURG INTEGRATIVE MEDICINE PLLC | 863416353 - (WA) ELLENSBURG INTEGRATIVE MEDICINE PLLC | WA | Multi-Specialty Group (193200000X) |
United | 31242 | $3904.15 | 1164463204 - CARLEEN BENSEN | 562574968 | WA | Urology Physician (208800000X) |
United | 31242 | $4805.10 | 1083925168 - INNOVATIVE SLEEP CENTERS, PLLC, NORTHWEST NEUROLOGY AND MEMORY CLINIC | 272870389 - (WA) INNOVATIVE SLEEP CENTERS PLLC | WA | Multi-Specialty Group (193200000X) |
United | 31242 | $7395.37 | 1376867929 - GAVRIEL KOHLBERG | 912047402 | WA | Otolaryngology Physician (207Y00000X) |
United | 31242 | $3678.91 | 1710603907 - COMMUNITY VASCULAR WASHINGTON, PLLC | 883802077 - (WA) COMMUNITY VASCULAR WASHINGTON PLLC | WA | Multi-Specialty Group (193200000X) |
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 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 | Moderate | Nasal/Sinus Endoscopy, Surgical; With Destruction By Radiofrequency Ablation, Posterior Nasal Nerve - Deny Inv/N10>=12/31/2024 |
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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