CPT 31290 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • LT - Left side of body • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31290 |
National average reimbursement for CPT 31290 by major payers:
$1,495.26
$1,522.77
$1,609.61
$1,903.05
| 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 31290 | ||||||
United | 31290 | $159.00 | 1770532194 - BROADWEST SPECIALTY SURGICAL CENTER, LLC | 710991736 - (IN) BROADWEST SPECIALTY SURGICAL 401 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $400.00 | 1487742680 - NOVAMED SURGERY CENTER OF CLEVELAND LLC, THE SURGERY CENTER OF CLEVELAND | 205493062 - (TN) NOVAMED SURGERY CENTER OF CLEVELAND LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $973.00 | 1083659866 - ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP, FOUNDATION SURGERY AFFILIATE OF SAN ANTONIO LP | 742976746 - (TX) ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $300.00 | 1174615702 - I CARE CENTER LLC, CENTRAL INDIANA SURGERY CENTER | 351937200 - (IN) ICARE CENTER DBA CENTRAL INDIANA SURGERY CENTER, LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $624.00 | 1457325573 - ST GEORGE ENDOSCOPY CENTER LLC, ST. GEORGE ENDOSCOPY CENTER | 43650097 - (UT) ST GEORGE ENDOSCOPY CENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $1049.00 | 1295479780 - ADVENTHEALTH SURGERY CENTER DAVENPORT LLC | 881811228 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $867.00 | 1912600826 - SURGICAL CENTER OF TVH | 882585662 - (ID) SURGICAL CENTER OF TVH | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $540.00 | 1922022425 - CASCADE SURGERY CENTER LLC | 202354326 - (OR) CASCADE SURGERY CENTER LLC | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $725.00 | 1699328369 - GEORGIA UROLOGY, PA | 550846177 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $1274.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $1064.00 | 1194239483 - ATLANTIC COAST SURGICAL SUITES, LLC | 822449256 - (NH) ATLANTIC COAST SURGICAL SUITES LLC | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $150.00 | 1740264811 - EYES OF YORK SURGICAL CENTER LLC | 200930310 - (PA) EYES OF YORK SURGICAL CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $1039.00 | 1104933696 - WEST LAKES SURGERY CENTER LLC | 205345295 - (IA) WEST LAKES SURGERY CENTER, LLC | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $226.00 | 1215994280 - SLOAN EYE CLINIC, ARKANSAS SURGERY CENTER | 710815680 - (AR) SLOAN EYE CLINIC | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31290 | $1049.00 | 1093085904 - ARIZONA ADVANCED ENDOSCOPY LLC | 453051125 - (AZ) ARIZONA ADVANCED ENDOSCOPY, LLC | AZ | 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 31290 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31290 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 31290 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 |
|---|---|---|
| 31290-CPT | High | Endoscopy, Surg, W Repair Of Cerebrospinal Fluid Lead; Ethmoid Region |
| 31291-CPT | High | Endoscopy, Surg, W Repair Of Cerebrospinal Fluid Leak; Sphenoid Region |
| 31292-CPT | High | Nasal/Sinus Endoscopy Surgical With Orbital Decompression; Medial Or Inferior Wall (Desc Rvsd 1/1/20) |
| 31293-CPT | High | Nasal/Sinus Endoscopy Surgical With Orbital Decompression; Medial And Inferior Wall (Desc Rvsd 1/1/20) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31290. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31290 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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