CPT 31256 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 31256 by major payers:
$277.17
$253.59
$280.64
$312.75
| 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 31256 | ||||||
United | 31256 | $1070.00 | 1780292110 - BUCKEYE SOUTH LLC, BUCKEYE SURGERY CENTER | 832419523 - (AZ) BUCKEYE SOUTH LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $1862.00 | 1205889110 - SOUTH COAST SURGERY CENTER, LLC | 931201612 - (OR) SOUTH COAST SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $3473.00 | 1114435856 - EINSTEIN MEDICAL CENTER MONTGOMERY, EINSTEIN ENDOSCOPY CENTER - BLUE BELL | 204193243 - (PA) ALBERT EINSTEIN HEALTHCARE NETWORK | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $530.00 | 1457306888 - PMTC SURGERY CENTER, INC | 731651884 - (WI) PMTC SURGERY CENTER INC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $1250.00 | 1619971470 - ARIZONA ADVANCED SURGERY CENTER, LLC | 202770438 - (AZ) ARIZONA ADVANCED SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $1135.00 | 1285630160 - NOVAMED EYE SURGERY CENTER OF NORTH COUNTY, LLC, WOODCREST SURGERY CENTER | 364111316 - (MO) NOVAMED EYE SURGERY CENTER OF NORTH COUNTY LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $2206.00 | 1366935074 - SKYWAY SURGERY CENTER, LLC | 813237016 - (FL) SKYWAY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $853.00 | 1083638647 - WEST DES MOINES AMBULATORY SURGICAL CENTER LLC, WESTOWN AMBULATORY CENTER | 421469883 - (IA) WEST DES MOINES AMBULATORY SURGICAL CENTER LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $1205.00 | 1992794580 - VALLEY MEDICAL PLAZA AMBULATORY | 731718858 - (CA) VALLEY MEDICAL PLAZA AMBULATORY | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $1762.00 | 1942335971 - PALOS SURGICENTER, LLC | 364404305 - (IL) PALOS SURGICENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $3264.00 | 1316317134 - SUMMER STREET ASC LLC | 474990107 - (CT) SUMMER STREET ASC LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $3563.00 | 1609907211 - SHREWSBURY SURGERY CENTER, LLC, SHREWSBURY SURGERY CENTER | 223651945 - (NJ) SHREWSBURY SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $877.00 | 1043208283 - TRACEY A. SCHMUCKER, M.D., P.A., LOWERY SURGERY CENTER | 262165143 - (AR) TRACEY A SCHMUCKER MD PA | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $780.00 | 1669481255 - SURGERY CENTER OF CULLMAN LLC, HEALTHSOUTH/WOODLANDS SURGERY CENTER OF CULLMAN, LLC | 203489003 - (AL) SURGERY CENTER OF CULLMAN LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31256 | $1148.00 | 1326048091 - LOURDES AMBULATORY SURGERY CENTER LLC | 205588350 | KY | 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 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 |
|---|---|---|
| 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) |
| 31256-CPT | Moderate | Nasal/Sinus Endoscopy Surg;W/Frontal;Exploration,Incld Removal |
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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