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See a sample rate comparisonCPT 31256 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.
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.
| 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 31256 |
| Medicaid Fee Schedule | View Medicaid rates for 31256 |
National average reimbursement for CPT 31256 by major payers:
$277.17
$253.59
$280.64
$306.45
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CPT 31256
5 of 25 sample ratesHigher to lower in this preview
Henry Ford Medical Center Fairlane, Henry Ford Health System
Henry Ford Health System
$6,682.00Published rateShrewsbury Surgery Center, LLC, Shrewsbury Surgery Center
Shrewsbury Surgery Center LLC
$2,841.00Published rateSkyway Surgery Center, LLC
Skyway Surgery Center LLC
$2,206.00Published rateBiltmore Surgical Partners, LLC, Deer Valley Surgical And Endoscopy Center
Biltmore Surgical Partners LLC
$1,380.00Published rateThe Eye Physicians Of Pinellas, PA, Largo Ambulatory Surgery Center
The Eye Physicians Of Pinellas, P.A.
$551.00Published rate
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See a sample payer proposalCPT 31256 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31256 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 31256 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 |
|---|---|---|
| 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. |
| 31257-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Sphenoidotomy Imary Procedure) Tery Disease Data Preparation And Transmission A |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31256. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31256 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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