CPT 31296 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 | • None • 50 - Bilateral Procedure • LT - Left side of body |
| Complexity Level | High |
National average reimbursement for CPT 31296 by major payers:
$2,610.25
$3,300.91
$3,132.52
$3,293.03
| 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 31296 | ||||||
United | 31296 | $2000.00 | 1225684368 - FORT WAYNE VASCULAR CARE LLC, NEPHROLOGY ASSOCIATES OF NORTHERN INDIANA PC | 364859870 - (IN) FORT WAYNE VASCULAR CARE LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $4815.00 | 1841858024 - VANGUARD ASC, LLC, VANGUARD SURGICAL CENTER | 352661529 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $956.00 | 1386823854 - THE GLENDALE AZ ENDOSCOPY ASC LLC, THUNDERBIRD ENDOSCOPY CENTER | 260506545 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1400.00 | 1871596114 - NORTHERN ARIZONA SURGICENTER, LLC | 860747413 - (AZ) NORTHERN ARIZONA SURGICENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1530.00 | 1689059222 - GOLDSTEP AMBULATORY SURGERY CENTER, LLC | 465647464 - (NY) GOLDSTEP AMBULATORY SURGERY CENTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $12000.00 | 1750071007 - DISC SURGERY CENTER AT MARINA DEL REY LLC | 880601479 - (CA) DISC SURGERY CENTER AT MARINA DEL REY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $2637.00 | 1407227358 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, BAPTIST HEALTH SURGERY CENTER AT NORTHPOINT | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3347.00 | 1326435926 - SELECT PHYSICIANS SURGERY CENTERS | 383935220 - (FL) SELECT PHYSICIANS SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1016.00 | 1417118407 - MSC AMBULATORY SURGICAL CENTER, LLC | 202155076 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1950.00 | 1659463669 - ARUSHA LLC, THE SURGERY CENTER OF CHESTER COUNTY | 233076222 - (PA) ARUSHA LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1624.00 | 1992794580 - VALLEY MEDICAL PLAZA AMBULATORY | 731718858 - (CA) VALLEY MEDICAL PLAZA AMBULATORY | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $713.00 | 1689646937 - OCALA ENDOSCOPY ASC LP, ENDOSCOPY CENTER OF OCALA | 621650750 - (FL) OCALA ENDOSCOPY ASC LP | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $815.00 | 1770581829 - PHYSICIANS' SURGERY CENTER, LLC | 481217506 - (KS) PHYSICIANS SURGERY CENTER, L.L.C. | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $11871.00 | 1538292990 - TEXAS HEALTH HARRIS METHODIST HOSPITAL FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3186.00 | 1003119470 - MOUNTAIN WEST SURGERY CENTER, LLC | 371614424 | UT | 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 31296 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31296 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 31296 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 |
|---|---|---|
| 31267-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical, With Maxillary Antrsotomy; With Removal Of Tissue From Maxillary Sinus |
| 31276-CPT | Moderate | Nasal/Sinus Endoscopy Surgical With Frontal Sinusexploration Including Removal Of Tissue From Frontal Sinus When Performed (Desc Revised 1/1/2018) |
| 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 31296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31296 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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