CPT 31259 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 |
| Medicare Fee Schedule | View Medicare rates for 31259 |
National average reimbursement for CPT 31259 by major payers:
$687.71
$640.49
$674.01
$793.03
| 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 31259 | ||||||
United | 31259 | $3500.00 | 1063092047 - TAMPA BAY JOINT AND SPINE, LLC, TAMPA BAY JOINT AND SPINE SURGERY CENTER | 851259146 - (FL) TAMPA BAY JOINT AND SPINE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $1500.00 | 1760991921 - COLUMBIA NEPHROLOGY ASSOCIATES PA | 570702722 - (SC) THE COLUMBIA NEPHROLOGY ASSOCIATES, P.A. | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $1590.00 | 1598775231 - SURGERY CENTER OF COLUMBIA COUNTY, LLC, SURGERY CENTER OF COLUMBIA COUNTY | 743171980 - (GA) SURGERY CENTER OF COLUMBIA CTY | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $3698.00 | 1184752305 - SEASHORE SURGICAL INSTITUTE, LLC | 223660141 - (NJ) SEASHORE SURGICAL INSTITUTE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $3500.00 | 1891298089 - MICHIGAN OUTPATIENT SURGICAL SOLUTIONS, LLC | 821706937 - (MI) MICHIGAN OUTPATIENT SURGICAL SOLUTIONS LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $1825.00 | 1164584066 - NAPERVILLE SURGICAL CENTRE LLC | 200433367 - (IL) NAPERVILLE SURGICAL CENTRE, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $3350.00 | 1407812498 - LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | 364119522 - (IL) LOYOLA AMBULATORY SURGERY CENTER AT OAKBROOK LP | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $2792.00 | 1053565259 - SOUTHWEST LINCOLN SURGERY CENTER, LLC, SOUTHWEST LINCOLN SURGERY CENTER | 262981972 - (NE) SOUTHWEST LINCOLN SURGERY CENTER LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $2835.00 | 1619614963 - VALLEY SURGERY CENTER LLC | 873516980 - (WI) VALLEY SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $10978.00 | 1578561890 - THE ENDOSCOPY CENTER AT ST. FRANCIS, LLC | 351958962 - (IN) THE ENDOSCOPY CENTER AT ST FRANCIS LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $3570.00 | 1003861998 - PHYSICIANS SURGERY CENTER OF CHATTANOOGA, LLC, PHYSICIANS SURGERY CENTER OF CHATTANOOGA | 621817952 - (TN) PHYSICIANS SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $2400.00 | 1396832549 - GENESEE CARE L.L.C., THE SURGERY CENTER OF GENESEE COUNTY | 383242685 - (MI) GENESEE CARE LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $2100.00 | 1225523970 - BURNSVILLE SURGERY CENTER, P.A. | 830965169 - (MN) BURNSVILLE SURGERY CENTER PA | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $6855.00 | 1013548833 - ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT LLC, ASCENSION WISCONSIN SURGERY CENTER-MOUNT PLEASANT | 843972619 - (WI) ASCENSION WISCONSIN SURGERY CENTERMOUNT PLEASANT LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31259 | $2456.00 | 1700807617 - ENDOSCOPY CENTER OF THE ROCKIES LLC, ENDOSCOPY CENTER OF THE ROCKIES LAFAYETTE | 841562782 - (CO) ENDOSCOPY CENTER OF THE ROCKIES LLC | CO | 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 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 | 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) |
| 31256-CPT | Moderate | Nasal/Sinus Endoscopy Surg;W/Frontal;Exploration,Incld Removal |
| 31259-CPT | Moderate | Nasal/Sinus Endoscopy Surgical With Ethmoidectomy;Total (Anterior And Posterior) Including Sphenoidotomy With Removal Of Tissue From The Sphenoid Sinus |
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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