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See a sample rate comparisonCPT 31254 Fee Schedule
Last Verified: October 2026
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.
Nose Or Sinus Surgery, Nose Or Sinus Surgery Aided By A Scope (Endoscopy) To Improve Drainage From The Sinus Between The Eye And Nose (Ethmoid Sinus). The Procedure May Remove Excess Tissue.
| 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 |
| Medicare Fee Schedule | View Medicare rates for 31254 |
| Medicaid Fee Schedule | View Medicaid rates for 31254 |
National average reimbursement for CPT 31254 by major payers:
$463.47
$475.55
$556.66
$423.95
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CPT 31254
5 of 25 sample ratesHigher to lower in this preview
Jewett Orthopedic Institute Surgery Center, LLC
Jewett Orthopedic Institute Surgery Center LLC
$3,350.00Published rateAscension Saint Thomas Lebanon Surgery Center LLC, Lebanon Surgery Center
$2,307.00Published rateGeorgia Urology, PA
$1,647.00Published rateAlexander Eye Surgery Center, LLC
$935.00Published rateMichael Hinton
Lake Charles Medical Services Orthopedics Associates LLC
$549.53Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 31253-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Frontal Sinus Exploration With Removal Of Tissue From Frontal Sinus When Performed Imary Procedure) Tery Disease Data Preparation And Transmission A |
| 31254-CPT | Moderate | Nose Or Sinus Surgery, Nose Or Sinus Surgery Aided By A Scope (Endoscopy) To Improve Drainage From The Sinus Between The Eye And Nose (Ethmoid Sinus). The Procedure May Remove Excess Tissue. |
| 31255-CPT | Moderate | Nose Or Sinus Surgery, Nose Or Sinus Surgery Aided By A Scope (Endoscopy) To Improve Drainage From The Sinus Between The Eye And Nose (Ethmoid Sinus). The Procedure May Remove Excess Tissue. |
| 31256-CPT | Moderate | Scope Surgery Of Nose Or Sinus, Surgery Aided By A Scope (Endoscopy) On The Nose Or Sinus. The Procedure May Include Draining A Sinus Or Removing Abnormal Tissue Such As Polyps. |
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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