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 |
| Medicare Fee Schedule | View Medicare rates for 31612 |
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 | $1180.00 | 1518450790 - VIRGINIA ENT SURGERY CENTER INC | 541052755 - (VA) VIRGINIA EAR, NOSE & THROAT ASSOCIATES, P.C. | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2254.00 | 1598165664 - WESTHEALTH SURGERY CENTER LLC | 371763155 - (MN) WESTHEALTH SURGERY CENTER LLC | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2307.00 | 1295060069 - TIMONIUM SURGERY CENTER, LLC | 270399689 - (MD) TIMONIUM SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1658.00 | 1497011308 - BENJAMIN CHUNG MD INC, RIVERWALK SURGERY CENTER | 454738248 - (CA) BENJAMIN CHUNG MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2275.00 | 1306556907 - THE VANCOUVER CLINIC INC PS, SALMON CREEK 2 AMBULATORY SURGERY CENTER | 910851599 - THE VANCOUVER CLINIC, INC., PS | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $846.00 | 1225440969 - COPPEL SURGICAL SOLUTIONS, NEVADA SURGICAL SUITES | 460641933 - (NV) COPPEL SURGICAL SOLUTIONS | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $67.23 | 1356009468 - MELISSA MCKINNEY | 350593390 - DEACONESS HOSPITAL INC | KY | Certified Registered Nurse Anesthetist (367500000X) |
United | 31612 | $1074.00 | 1043497019 - PIKESVILLE MD ENDOSCOPY ASC LLC, ENDOCENTRE OF BALTIMORE | 261467040 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2353.00 | 1841712452 - SAINT THOMAS SURGERY CENTER NEW SALEM, LLC | 822137177 - (TN) SAINT THOMAS SURGERY CENTER NEW SALEM LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $2900.00 | 1538164546 - SURGERY CENTER AT PELHAM, LLC | 760745215 - (SC) SURGERY CENTER AT PELHAM, LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1530.00 | 1326551623 - UNITED VASCULAR OF OMAHA LLC | 822359316 - (NE) UNITED VASCULAR OF OMAHA LLC | NE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $3871.00 | 1164017778 - MEDICAL CITY SURGERY CENTER OF ALLIANCE, LLC | 822480225 - (TX) MEDICAL CITY SURGERY CENTER OF ALLIANCE LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1148.00 | 1043612534 - HHC ASC, LLC | 824195385 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1600.00 | 1619926755 - EYE SURGERY CTR OF SO CALIF A MED GROUP, TRI-CITY SURGERY CENTER | 953856768 - (CA) EYE SURGERY CTR OF SO CALIF A MED GROUP | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 31612 | $1134.00 | 1295240133 - BRAINARD SURGERY CENTER LLC | 823600153 - (OH) BRAINARD SURGERY CENTER LLC | OH | 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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