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See a sample rate comparisonCPT 31820 Fee Schedule
Last Verified: October 2026
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.
Surg.Cl.Trachestmy/Fist;W/O Pl.Repr
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Respiratory System |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | GC - Service performed by resident under supervision AG - Primary physician 51 - Multiple procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $445.90 national non-facility rate (2026) · View Medicare rates for 31820 |
| Medicaid Fee Schedule | $350.095 median of the 8 states in the free preview · View Medicaid rates for 31820 |
National average reimbursement for CPT 31820 by major payers:
$508.45
$564.74
$617.87
$548.81
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CPT 31820
5 of 25 sample ratesHigher to lower in this preview
Cp Surgery Center, LLC
$3,993.00Published rateEast Brunswick Surgery Center LLC, University Surgicenter
East Brunswick Surgery Center
$2,578.00Published rateSunset Ridge Surgery Center, LLC
$1,586.00Published rateNorthwest Atlanta Vascular Care LLC
$1,245.00Published rateIndependence Asc LLC, The Endoscopy Center - Liberty
$622.00Published rate
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See a sample payer proposalCPT 31820 vs. Other Surgical Procedures on the Respiratory System Codes
The CPT 31820 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 31820 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 |
|---|---|---|
| 31800-CPT | Moderate | Suture Ext.Tracheal Wound/Inj;Cerv |
| 31805-CPT | High | Suture Ext Trach Wound Intrathorac |
| 31820-CPT | Moderate | Surg.Cl.Trachestmy/Fist;W/O Pl.Repr |
| 31825-CPT | Moderate | Close Surgical Wound In Neck, Surgery To Close An Opening In The Windpipe (Trachea). The Procedure Can Include Cosmetic Surgery. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 31820. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 31820 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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