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 |
| Medicare Fee Schedule | View Medicare rates for 31296 |
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 | $1410.00 | 1720278047 - ARIZONA INSTITUTE OF EYE SURGERY LLC, PRESCOTT VISION & EYE SURGERY CENTER | 142002653 - (AZ) ARIZONA INSTITUTE OF EYE SURGERY, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1980.00 | 1760465207 - PLASTIC SURGICAL CENTER OF RAPID CITY, PROF. L.L.C. | 460441899 - (SD) PLASTIC SURGICAL CENTER OF RAPID CITY PROF LLC | SD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1703.00 | 1770911463 - SALUBRIOUS ASC, LLC | 463866454 - (GA) SALUBRIOUS ASC LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3570.00 | 1962671487 - HYDE PARK SURGERY CENTER, LLC, HYDE PARK SURGERY CENTER, LP | 421731685 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $2100.00 | 1750874400 - DENVER DIAGNOSTIC ASC, LLC | 825510334 - (CO) DENVER DIAGNOSTIC ASC LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $2011.00 | 1659842128 - MILESTONE SURGICAL CENTER LLC | 824967929 - (CO) MILESTONE SURGICAL CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $1346.00 | 1730130246 - PENNSYLVANIA EYE SURGERY CENTER, INC., MEMORIAL EYE INSTITUTE | 232262909 - (PA) PENNSYLVANIA EYE SURGERY CENTER, INC. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3500.00 | 1538461348 - THE OUTPATIENT CENTER, LLC, THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. D/B/A THE OUTPATIENT CENT | 650440864 - (FL) THE OUTPATIENT CENTER OF BOYNTON BEACH, LTD. | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3575.00 | 1649500950 - NATIONAL AMBULATORY SURGERY CENTER, LLC | 271343081 - (CA) NATIONAL AMBULATORY SURGERY CENTER, LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3500.00 | 1518154517 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31296 | $3570.00 | 1548217128 - GULFSHORE ENDOSCOPY CENTER LLC | 650615196 - (FL) GULFSHORE ENDOSCOPY CENTER LLC | FL | 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 | $1016.00 | 1417118407 - MSC AMBULATORY SURGICAL CENTER, LLC | 202155076 | MD | 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 | 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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