CPT 31297 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 • RT - Right side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31297 |
National average reimbursement for CPT 31297 by major payers:
$2,909.30
$3,249.91
$2,965.33
$3,225.79
| 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 31297 | ||||||
United | 31297 | $1319.00 | 1245297662 - WOODLAND SURGERY CENTER LLC | 391998961 - (WI) WOODLAND SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $3384.62 | 1225424203 - MICHAEL ALBRING | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 31297 | $1850.00 | 1477655801 - CATARACT AND LASER CENTER ASSOCIATES PC | 43359062 - (MA) CATARACT AND LASER CENTER ASSOCIATES PC | MA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $2300.00 | 1437794625 - VANCE THOMPSON VISION SURGERY CENTER BILLINGS, LLC | 843362063 | MT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $850.00 | 1881728590 - SYSTEM OPTICS LLC | 341572960 - (OH) SYSTEM OPTICS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $520.00 | 1740277821 - TRANSSOUTH HEALTH CARE PLLC, TRANSSOUTH HEALTH CARE PC | 621453805 - (TN) TRANSSOUTH HEALTH CARE, P.C. | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $1549.00 | 1578221479 - SKIN CANCER AND LASER SURGERY CENTER LLC | 854119523 - (IN) SKIN CANCER AND LASER SURGERY CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $3491.00 | 1194724690 - ENDOSCOPY CENTER OF DAYTON NORTH LLC | 311703317 - (OH) ENDOSCOPY CENTER OF DAYTON NORTH LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $5177.00 | 1164486809 - SAINT LUKE'S SURGICENTER | 470853481 - (MO) SAINT LUKES SURGICENTER | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $3384.62 | 1700855244 - THOMAS GREEN | 350593390 - DEACONESS HOSPITAL INC | NC | Internal Medicine Physician (207R00000X) |
United | 31297 | $1309.00 | 1033116892 - CENTER FOR UROLOGIC CARE OF BERKS CO PC, BERKS UROLOGIC SURGERY CENTER | 231727298 - (PA) CENTER FOR UROLOGIC CARE OF BERKS COUNTY, P.C. | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $881.00 | 1255303517 - ST DOMINIC AMBULATORY SURGERY CENTER L L C | 640908713 - (MS) ST DOMINIC AMBULATORY SURGERY CENTER L L C | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $2353.00 | 1285215301 - LAKEWOOD RANCH SURGICAL SUITES, LLC | 842624445 - (FL) LAKEWOOD RANCH SURGICAL SUITES LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $1530.00 | 1871104836 - CENTER FOR PAIN MANAGEMENT AMBULATORY SURGERY, LTD | 205545259 - (MN) CENTER FOR PAIN MANAGEMENT AMBULATORY SURGERY LTD | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31297 | $6133.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | 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 31297 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31297 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 31297 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 |
|---|---|---|
| 31235-CPT | Moderate | Nasal/Sinus Endoscopy Diagnostic; With Sphenoid Sinusoscopy (Via Puncture Of Sphenoidal Face Or Cannulation Of Ostium) (Desc Rvsd 1/1/20) |
| 31294-CPT | High | Nasal/Sinus Endoscopy Surgical With Optic Nerve Decompression (Desc Rvsd 1/1/20) |
| 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 |
| 31297-CPT | High | Nasal/Sinus Endoscopy, Surgical, With Dilation; Sphenoid 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 31297. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31297 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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