CPT 31253 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 • 50 - Bilateral Procedure • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 31253 by major payers:
$730.83
$679.21
$711.97
$839.76
| 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 31253 | ||||||
United | 31253 | $5369.00 | 1124305065 - BAYLOR SCOTT & WHITE MEDICAL CENTERS, BAYLOR SCOTT & WHITE MEDICAL CENTER - MCKINNEY | 751037591 - (TX) BAYLOR MEDICAL CENTERS AT GARLAND AND MCKINNEY | TX | General Acute Care Hospital (282N00000X) |
United | 31253 | $5193.00 | 1215969787 - TENET HOSPITALS LIMITED, THE HOSPITALS OF PROVIDENCE SIERRA CAMPUS | 954537720 | TX | General Acute Care Hospital (282N00000X) |
United | 31253 | $4758.00 | 1669569984 - IRVING-COPPELL SURGICAL HOSPITAL LLP, BAYLOR SCOTT & WHITE SURGICAL HOSPITAL - LAS COLINAS | 542086863 | TX | General Acute Care Hospital (282N00000X) |
United | 31253 | $6110.00 | 1144781501 - BAYLOR SCOTT & WHITE MEDICAL CENTERS, BAYLOR SCOTT & WHITE MEDICAL CENTER - BUDA | 813040663 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTERS-CAPITOL AREA | TX | General Acute Care Hospital (282N00000X) |
United | 31253 | $7899.00 | 1124074273 - METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P., METHODIST HOSPITAL | 742730328 | TX | General Acute Care Hospital (282N00000X) |
United | 31253 | $2500.00 | 1407305063 - GASTROENTEROLOGY OF WESTCHESTER, LLC, GASTROENTEROLOGY OF WESTCHESTER, LLC | 821095121 - (NY) GASTROENTEROLOGY OF WESTCHESTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $3570.00 | 1619637543 - GAB ENDOSCOPY CENTER LLC | 372021101 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $978.00 | 1487094058 - COMPREHENSIVE PAIN CENTER FOR SURGERY, FOUNTAINS SPECIALTY SURGICAL CENTER | 460896509 - (MS) COMPREHENSIVE PAIN CENTER FOR SURGERY | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $3570.00 | 1841251501 - ST AUGUSTINE ENDOSCOPY CENTER LLC | 592947745 - (FL) ST AUGUSTINE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $3464.00 | 1295776920 - ROSE AMBULATORY SURGERY CENTER LP | 200415436 - (CO) ROSE AMBULATORY SURGERY CENTER LP | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $1807.00 | 1073570552 - PHYSICIANS SURGICAL CENTER LLC, PHYSICIANS SURGICAL CENTER, AN AFFILIATE OF HEALTHSOUTH | 731452371 - (OK) PHYSICIANS SURGICAL CENETER, L.L.C. | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $1941.00 | 1225665292 - ANNAPOLIS ENDOSCOPY CENTER LLC | 843556524 - (MD) ANNAPOLIS ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $1186.00 | 1831125962 - APAC SURGICAL CENTER II, LLC, APAC SURGERY CENTER II LLC | 352100376 - (IN) APAC SURGICAL CENTER II LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $1305.00 | 1043282775 - BALTIMORE ENDOSCOPY ASC LLC, GASTROINTESTINAL DIAGNOSTIC CENTER | 621760110 - (MD) BALTIMORE ENDOSCOPY ASC LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31253 | $962.00 | 1871052712 - KURESMART PAIN MANAGEMENT SURGERY CENTER-COLUMBIA LLC, CLEARWAY SURGERY CENTER OF COLUMBIA | 834028893 - (MD) KURESMART PAIN MANAGEMENT SURGERY CENTERCOLUMBIA LLC | 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 31253 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31253 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 31253 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 |
|---|---|---|
| 31253-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical With Ethmoidectomy; Total (Anterior And Posterior), Including Frontal Sinus Exploration, With Removal Of Tissue From Frontal Sinus, When Performed |
| 31254-CPT | Moderate | Nasal/Sinus Endoscopy Surgical With Ethmoidectomy; Partial (Anterior) (Desc Revised 1/1/2018) |
| 31255-CPT | Moderate | Nasal/Sinus Endoscopy Surgical With Ethmoidectomy; Total (Anterior And Posterior) (Desc Revised 1/1/2018) |
| 31257-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical With Ethmoidectomy; Total (Anterior And Posterior), Including Sphenoidotomy |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31253. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31253 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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