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See a sample rate comparisonCPT 31259 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.
Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Sphenoidotomy With Removal Of Tissue From The Sphenoid Sinus Imary Procedure) Tery Disease Data Preparation And Transmission A
| 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 31259 |
| Medicaid Fee Schedule | View Medicaid rates for 31259 |
National average reimbursement for CPT 31259 by major payers:
$687.71
$640.49
$674.01
$771.31
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CPT 31259
5 of 25 sample ratesHigher to lower in this preview
The Endoscopy Center At St. Francis, LLC
The Endoscopy Center At St Francis LLC
$10,978.00Published rateMichigan Outpatient Surgical Solutions, LLC
Michigan Outpatient Surgical Solutions LLC
$3,500.00Published rateGenesee Care L.L.C., The Surgery Center Of Genesee County
Genesee Care LLC
$2,400.00Published rateA Center For Foot And Ankle Surgery PA, The Center For Special Surgery Of Hawthorne
A Center For Foot And Ankle Su
$1,556.00Published rateVision Institute Of Michigan Surgery Center PC, Surgery Center Of Michigan
$643.00Published rate
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See a sample payer proposalCPT 31259 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31259 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 31259 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 |
| 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 |
| 31259-CPT | Moderate | Nasalsinus Endoscopy Surgica, Nasalsinus Endoscopy Surgical With Ethmoidectomy Total (Anterior And Posterior) Including Sphenoidotomy With Removal Of Tissue From The Sphenoid Sinus 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 31259. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31259 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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