CPT 31612 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 51 - Multiple procedures |
| Complexity Level | Low |
National average reimbursement for CPT 31612 by major payers:
$107.49
$110.67
$122.95
$145.25
| 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 31612 | ||||||
United | 31612 | $300.00 | 1306964853 - GASTROENTEROLOGY ENDOSCOPY CENTER | 582349040 - (GA) GASTROENTEROLOGY ENDOSCOPY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2689.00 | 1679086078 - CYPRESS CREEK OUTPATIENT SURGICAL CENTER, LLC | 460552249 - (FL) CYPRESS CREEK OUTPATIENT SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2000.00 | 1124247846 - ADVANCED SURGICAL ARTS CENTER LLC | 550815800 - (NJ) ADVANCED SURGICAL ARTS CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2135.00 | 1144380163 - THE CENTRE LLC | 352121237 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1042.00 | 1164419842 - MONTGOMERY SURGERY CENTER LLC. | 233078434 - (PA) MONTGOMERY SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $926.00 | 1629153770 - COTTMAN AMBULATORY SURGERY CENTER, WILLS SURGERY CENTER OF THE NORTHEAST | 232786584 - (PA) COTTMAN AMBULATORY SURGERY CENTER | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1120.00 | 1942202221 - NORTHLAKE ENDOSCOPY, LLC | 721515370 - (LA) NORTHLAKE ENDOSCOPY LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1140.00 | 1295710002 - SCOTTSDALE EYE SURGERY CENTER, P.C | 860566687 - (AZ) SCOTTSDALE EYE SURGERY CENTER | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2529.00 | 1962663559 - GASTROINTESTINAL ASSOCIATES ENDOSCOPY CENTER, LLC | 262157335 | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2948.00 | 1043874621 - BROWNSVILLE SURGICENTER, LLC | 825464594 - (TX) BROWNSVILLE SURGICENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1468.00 | 1588640353 - ENT REALTY CORP, THE SURGERY CENTER | 351846420 - (IN) ENT REALTY CORP | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $950.00 | 1639431653 - DESERT CLIFFS SURGERY CENTER LLC | 800824134 - (AZ) DESERT CLIFFS SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $975.00 | 1720080823 - BAPTIST-EMSC LP, EAST MEMPHIS SURGERY CENTER | 621846584 - (TN) BAPTISTEMSC LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2924.00 | 1477590545 - SOUTHERN HILLS MEDICAL CENTER, LLC, SOUTHERN HILLS HOSPITAL & MEDICAL CENTER | 743048428 - (NV) SOUTHERN HILLS MEDICAL CENTER LLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $467.00 | 1144326307 - OLD MOULTRIE SURGICAL CENTER INC | 593572609 - (FL) OLD MOULTRIE SURGICAL CENTER INC | FL | 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 31612 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31612 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 31612 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 |
|---|---|---|
| 31611-CPT | Moderate | Construction Of Tracheoesophageal Fistula And Subsequent Insertion Of An Alaryngeal Speech Prosthesis (Eg, Voice Button, Blom-Singer Prosthesis) |
| 31612-CPT | Low | Tracheal Puncture Percut.For Aspiration |
| 31614-CPT | Moderate | Tracheostoma Revision; Complex,W Flap Ro |
| 31622-CPT | Moderate | Bronchoscopy, Rigid Or Flexible, Including Fluoroscopic Guidance, When Performed; Diagnostic, With Cell Washing, When Performed (Separate Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31612. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31612 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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