CPT 31257 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 • RT - Right side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 31257 by major payers:
$614.86
$604.76
$640.95
$749.84
| 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 31257 | ||||||
United | 31257 | $2489.00 | 1083686208 - WICHITA ORTHOPAEDIC ASC LLC, SURGERY CENTER OF KANSAS | 621659908 - (KS) WICHITA ORTHOPAEDIC ASC LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $2056.00 | 1184798837 - SHADELANDS ADVANCED ENDOSCOPY INSTITUTE, INC. | 205834466 - (CA) SHADELANDS ADVANCED ENDOSCOPY INSTITUTE INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $1188.00 | 1689910739 - THE ENDOSCOPY CENTER AT BAINBRIDGE, LLC, UNIVERSITY SUBURBAN ENDOSCOPY CENTER | 205430025 - (OH) THE ENDOSCOPY CENTER AT BAINBRIDGE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $2081.00 | 1023169380 - JCMG SURGERY CENTER, INC. | 431809950 - (MO) JCMG SURGERY CENTER INC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $3347.00 | 1750823886 - LAKE ENDOSCOPY CENTER, LLC | 814225104 - (FL) LAKE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $2061.00 | 1548223068 - COLUMBIA SURGICARE OF AUGUSTA, LTD | 621671906 - (GA) COLUMBIA SURGICARE OF AUGUSTA LTD | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $2200.00 | 1538549852 - BAKERSFIELD SPECIALISTS SURGICAL CENTER, LLC | 465765998 - (CA) BAKERSFIELD SPECIALISTS SURGICAL CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $3570.00 | 1245605633 - HARBOR HEIGHTS SURGERY CENTER, LLC | 473886948 - (MD) HARBOR HEIGHTS SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $3090.00 | 1700966710 - SURGERY CENTER OF KALAMAZOO LLC | 61694249 - (MI) SURGERY CENTER OF KALAMAZOO LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $3162.00 | 1942299441 - PAIN CARE OF NORTH TEXAS, LLC | 200081985 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $1201.00 | 1376518357 - ORLANDO FL ENDOSCOPY ASC LLC, CITRUS AMBULATORY SURGERY CENTER | 202873015 - ORLANDO FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $790.98 | 1942683263 - JAMES ALSOP | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 31257 | $1685.00 | 1801317904 - AUSTIN KIDNEY ASSOCIATES, P. A. | 461801594 - (TX) AUSTIN KIDNEY ASSOCIATES, P.A. | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $597.00 | 1396192241 - ANDERSON ENDOSCOPY CENTER LLC | 811947476 - (OH) ANDERSON ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31257 | $2117.00 | 1689986879 - DEER POINTE SURGICAL CENTER, LLC, POA SURGERY CENTER | 272384315 - (MD) DEER POINTE SURGICAL CENTER, 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 31257 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31257 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 31257 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 |
| 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 |
| 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 31257. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31257 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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