CPT 31365 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 • GC - Service performed by resident under supervision • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 31365 |
National average reimbursement for CPT 31365 by major payers:
$3,107.39
$3,273.66
$3,508.59
$4,141.96
| 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 31365 | ||||||
United | 31365 | $983.00 | 1730175159 - CHARLOTTE ENDOSCOPIC SURGERY CENTER LLC, CHARLOTTE SURGERY CENTER | 651071112 - (FL) CHARLOTTE ENDOSCOPIC SURGERY CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $315.00 | 1265455463 - THE ENDOSCOPY CENTER AT BEL AIR | 470863243 - (MD) THE ENDOSCOPY CENTER AT BEL AIR | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $1028.00 | 1811515034 - SALMON SURGERY CENTER LLC | 844895716 - (WA) SALMON SURGERY CENTER LLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $400.00 | 1043411648 - COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC | 562402712 - (GA) COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $300.00 | 1932204971 - GREENVILLE ENDOSCOPY CENTER INC | 570965754 - (SC) GREENVILLE ENDOSCOPY CENTER INC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $63.00 | 1740529064 - ASC DEVELOPMENT COMPANY, LLC | 203405773 - (MD) ASC DEVELOPMENT COMPANY LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $1650.00 | 1275071789 - KADLEC REGIONAL MEDICAL CENTER | 910655392 - KADLEC REGIONAL MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $6068.00 | 1801309612 - TEXAS HEALTH SURGERY CENTER ROCKWALL, LLC | 474425996 - (TX) TEXAS HEALTH SURGERY CENTER ROCKWALL LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $585.00 | 1518280684 - NORTHWEST SURGERY CENTER, INC. | 364663721 - (CA) NORTHWEST SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $1028.00 | 1174802045 - LEONARDTOWN SURGERY CENTER LLC | 452019132 - (MD) LEONARDTOWN SURGERY CENTER, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $399.00 | 1306320338 - ALABAMA EYE SURGERY CENTER LLC | 814662532 - (AL) ALABAMA EYE SURGERY CENTER LLC | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $1049.00 | 1134262868 - NORTH SHORE SAME DAY SURGERY LLC, NORTH SHORE SURGICAL CENTER | 364120432 - (IL) NORTH SHORE SAME DAY SURGERY LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $951.00 | 1629461934 - NORTHERN EC LLC | 464211412 | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $445.00 | 1285874065 - WEST CHASE SURGERY CENTER LTD | 260167338 - (FL) WEST CHASE SURGERY CENTER LTD | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31365 | $1463.00 | 1720001928 - CAMPBELL CLINIC SURGERY CENTER, LLC | 621826300 | TN | 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 31365 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31365 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 31365 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 |
|---|---|---|
| 31253-CPT | Moderate | Nasal/Sinus Endoscopy, Surgical With Ethmoidectomy; Total (Anterior And Posterior), Including Frontal Sinus Exploration, With Removal Of Tissue From Frontal Sinus, When Performed |
| 31290-CPT | High | Endoscopy, Surg, W Repair Of Cerebrospinal Fluid Lead; Ethmoid Region |
| 31299-CPT | High | Unlisted Procedure, Accessory Sinuses |
| 31365-CPT | High | Laryngectomy;Total With Radical Neck Dis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31365. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31365 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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