CPT 31295 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 | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • 50 - Bilateral Procedure • None • 51 - Multiple procedures |
| Complexity Level | High |
National average reimbursement for CPT 31295 by major payers:
$2,071.57
$2,611.00
$2,598.01
$2,955.79
| 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 31295 | ||||||
United | 31295 | $4375.00 | 1154590271 - UNITY SURGICAL CENTER, LLC, UNITY SURGICAL CENTER | 352099067 - (IN) UNITY SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $3353.00 | 1225648470 - UCSD AMBULATORY SURGERY CENTER, LLC | 261232189 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $3350.00 | 1689639692 - SURGICAL CENTER OF SOUTH JERSEY LIMITED PARTNERSHIP | 222709324 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $1209.00 | 1093736795 - HATTIESBURG CLINIC PA, AMBULATORY SURGERY CENTER | 640507572 - HATTIESBURG CLINIC, P.A. | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $1498.00 | 1770869927 - SYRACUSE SURGERY CENTER, LLC | 453629322 - (NY) SYRACUSE SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $1686.00 | 1477594422 - SURGERY CENTER OF AVENTURA LTD | 113765789 - (FL) SURGERY CENTER OF AVENTURA LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $2300.00 | 1841325214 - AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | 208422547 - (MD) AMBULATORY CENTER FOR AESTHETIC AND RECONSTRUCTIVE SURGERY | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $4781.00 | 1699144915 - WEST ORANGE ASC LLC, GREGORI SURGERY CENTER | 474739080 - (NJ) WEST ORANGE ASC LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $684.00 | 1962466847 - GULF COAST ENDOSCOPY CENTER OF VENICE LLC | 650954372 - (FL) GULF COAST ENDOSCOPY CENTER OF | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $2647.00 | 1417554155 - CENTER FOR RESTORATIVE SURGERY AT MAPLE GROVE, LLC | 853324771 - (MN) CENTER FOR RESTORATIVE SURGERY AT MAPLE GROVE LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $1325.00 | 1265438303 - EYE SURGERY CENTER OF CHATTANOOGA, LLC | 200149350 - (TN) EYE SURGERY CENTER OF CHATTANOOGA LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $1536.00 | 1669050654 - HEART & VASCULAR AMBULATORY SURGERY CENTER, LLC | 862335325 - (FL) HEART VASCULAR AMBULATORY SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $1170.00 | 1902849227 - EYE SURGERY CENTER, LLC | 371221499 - (IL) EYECARE MANAGEMENT, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $2250.00 | 1215309653 - BANGOR EYE SURGERY, PA | 473741642 - (ME) BANGOR EYE SURGERY PA | ME | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31295 | $2715.00 | 1871119107 - REGIONAL PLASTIC SURGERY CENTER PA, REGIONAL PLASTIC SURGERY CENTER - SHERMAN | 752365055 - (TX) REGIONAL PLASTIC SURGERY ASSOCIATES, P.A. | TX | 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 31295 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31295 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 31295 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 |
|---|---|---|
| 31225-CPT | High | Maxillectomy Wo Orbit Exenteration |
| 31267-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical, With Maxillary Antrsotomy; With Removal Of Tissue From Maxillary Sinus |
| 31295-CPT | High | Nasal/Sinus Endoscopy, Surgical, With Dilation; Maxillary Sinus Ostium - Rn Review>=3/7/2018; Deny Inv/N10=1/1/2011-3/6/2018 Except Uhs & City Of Knoxville |
| 31296-CPT | High | Nasal/Sinus Endoscopy, Surgical, With Dilation; Frontal Sinus Ostium - Rn Review>=3/7/2018; Deny Inv/N10=1/1/2011-3/6/2018 Except Uhs & City Of Knoxville |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31295. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31295 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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