CPT 31254 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 31254 by major payers:
$463.47
$475.55
$556.66
$660.26
| 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 31254 | ||||||
United | 31254 | $2621.00 | 1336649565 - ADVANCED SURGICAL CARE OF ST. LOUIS, LLC | 823086965 - (MO) ADVANCED SURGICAL CARE OF ST LOUIS LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $4405.00 | 1467920389 - KU MEDWEST AMBULATORY SURGERY CENTER, LLC | 20664568 - (KS) KU MEDWEST AMBULATORY SURGERY CENTER LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $1277.00 | 1831116698 - LASER AND OUTPATIENT SURGERY CENTER LLC | 201098451 - (FL) LASER AND OUTPATIENT SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $2915.00 | 1619333010 - ORANGE ASC, LTD, ORTHOPEDIC ONE SURGERY CENTER AT EASTON | 464700223 - (OH) ORANGE ASC LTD DBA ORTHOPEDIC ONE SURGERY CENTER AT EASTON | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $3350.00 | 1588312607 - JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER, LLC | 872667237 - (FL) JEWETT ORTHOPEDIC INSTITUTE SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $2353.00 | 1841251501 - ST AUGUSTINE ENDOSCOPY CENTER LLC | 592947745 - (FL) ST AUGUSTINE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $1196.00 | 1528622321 - PREMIER-COVENANT ASTC LLC, PREMIER AMBULATORY SURGERY CENTER | 834550993 - (TN) PREMIERCOVENANT ASTC LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $2388.00 | 1427003052 - EYE SURGERY CENTER OF NASHVILLE LLC | 621872622 - (TN) EYE SURGERY CENTER OF NASHVILLE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $2388.00 | 1437419660 - ADVANCED SURGERY CENTER OF METAIRIE LLC | 453386956 - (LA) ADVANCED SURGERY CENTER OF METAIRIE | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $1213.00 | 1609465269 - OKLAHOMA SPINE SURGERY CENTER | 861507485 - (OK) OKLAHOMA SPINE SURGERY CENTER | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $767.00 | 1093736795 - HATTIESBURG CLINIC PA, AMBULATORY SURGERY CENTER | 640507572 - HATTIESBURG CLINIC, P.A. | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $2859.00 | 1194935577 - MILLENNIUM SURGICAL CENTER LLC | 205225327 - (NJ) MILLENNIUM SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $1685.00 | 1316350275 - ORCHARD SURGICAL CENTER, LLC, ORCHARD SURGICAL CENTER | 465568612 - (NH) ORCHARD SURGICAL CENTER, LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $1600.00 | 1396796249 - TAMPA BAY SURGERY CENTER ASSOCIATES, LTD. | 593210851 - (FL) TAMPA BAY SURGERY CENTER ASSOC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31254 | $1393.00 | 1205808938 - ABILENE EYE ASC LP, ABILENE CATARACT AND REFRACTIVE SURGERY CENTER | 621678444 - (TX) ABILENE EYE ASC LP | TX | 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 31254 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31254 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 31254 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 |
|---|---|---|
| 31205-CPT | High | Ethmoidectomy Extranasal Total |
| 31240-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical; W/Biopsy, Polypectomy Or Debridement (Separate Procedure) With Concha Bullosa Resection |
| 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) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31254. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31254 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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