CPT 31291 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 • RT - Right side of body • LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31291 |
National average reimbursement for CPT 31291 by major payers:
$1,713.94
$1,621.06
$1,717.38
$2,019.05
| 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 31291 | ||||||
United | 31291 | $2172.00 | 1639146541 - CENTENNIAL ASC, LLC, BAYLOR SURGICARE AT CENTENNIAL | 352199232 - (TX) CENTENNIAL ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $900.00 | 1033195912 - SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC, AVERA ENDOSCOPY/SURGICAL CENTER | 460461429 - (SD) SURGICAL ASSOCIATES ENDOSCOPY CLINIC LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $9124.00 | 1215060546 - TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | 751752253 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL STEPHENVILLE | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $500.00 | 1033375399 - ABILENE SURGERY CENTER, LLC | 208816729 - (TX) ABILENE SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $1674.00 | 1396009346 - PARAMUS ENDOSCOPY LLC, ENDOSCOPY CENTER OF BERGEN COUNTY | 453979491 - (NJ) PARAMUS ENDOSCOPY LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $530.00 | 1518592021 - FIRST SURGERY CENTER, INC. | 842066148 - (CA) FIRST SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $391.00 | 1881704237 - WATERFRONT SURGERY CENTER LLC | 251898743 - (PA) WATERFRONT SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $7400.00 | 1386159853 - BELTWAY SURGERY CENTERS, LLC, EAGLE HIGHLANDS SURGERY CENTER | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $2172.00 | 1811995913 - DALLAS SURGICAL PARTNERS, LLC, BAYLOR SCOTT & WHITE SURGICARE | 752813815 - (TX) DALLAS SURGICAL PARTNERS LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $650.00 | 1730153073 - EAST MEMPHIS UROLOGY CENTER, LP, UROCENTER | 621810940 - (TN) EAST MEMPHIS UROLOGY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $162.00 | 1467429233 - WILLOW SPRINGS SURGERY CENTER, LTD, FOREST MED-SURG CENTER | 364391641 - (IL) WILLOW SPRINGS SURGERY CENTER LTD | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $420.00 | 1609030774 - SARASOTA PHYSICIANS SURGICAL CENTER, LLC | 432110985 - (FL) SARASOTA PHYSICIANS SURGICAL CENTER | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $528.00 | 1245331628 - BERNSTEIN HILLIKER HARTZELL EYE CENTER LLP, THE SURGERY CENTER OF CENTRAL PA | 232196399 - (PA) THE EYE CENTER OF CENTRAL PA, LLP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $1088.00 | 1417077090 - BAPTIST MEDICAL PARK SURGERY CENTER LLC | 593535262 - (FL) BAPTIST MEDICAL PARK SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31291 | $960.00 | 1619036381 - WILMINGTON AMBULATORY SURGICAL CENTER, LLC, AMERICAN SURGERY CENTER | 510385184 - (DE) WILMINGTON AMBULATORY SURGICAL CENTER LLC | DE | 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 31291 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31291 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 31291 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 31291. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31291 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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