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See a sample rate comparisonCPT 31243 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. Cold 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 31243 |
| Medicaid Fee Schedule | View Medicaid rates for 31243 |
National average reimbursement for CPT 31243 by major payers:
$3,042.68
$3,368.89
$2,875.01
$395.80
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CPT 31243
5 of 25 sample ratesHigher to lower in this preview
Columbia Valley Healthcare System, L.P., Valley Regional Medical Center
Columbia Valley Healthcare System Lp
$19,015.00Published rateDaniel Smith
The Polyclinic, PLLC
$6,028.12Published rateJeffrey Evans
$4,008.38Published rateBaton Rouge Orthopaedic Clinic, Ascension Orthopaedic Clinic
Baton Rouge Orthopaedic Clinic, LLC
$3,377.25Published rateJorge Isaza
Spine Specialists Of Louisiana
$187.36Published rate
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See a sample payer proposalCPT 31243 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31243 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 31243 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 |
|---|---|---|
| 31243-CPT | High | Treat Nerves At Back Of Nose, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. Cold 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 31243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31243 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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