CPT 35231 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 Cardiovascular System |
| Common Place of Service | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • LT - Left side of body • 78 - Return to OR - related procedure |
| Complexity Level | High |
National average reimbursement for CPT 35231 by major payers:
$1,772.03
$1,704.30
$1,808.37
$2,049.65
| 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 35231 | ||||||
United | 35231 | $753.00 | 1811914625 - PUGET SOUND GASTROENTEROLOGY, PLLC, EDMONDS ENDOSCOPY CENTER | 911123468 - (WA) PUGET SOUND GASTROENTEROLOGY, P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $2490.00 | 1275376121 - CLEARWAY SURGERY CENTER OF NATIONAL HARBOR LLC | 454110190 - (MD) HARBORSIDE SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $561.00 | 1083060107 - LASER SURGERY HOLDING COMPANY, LTD | 550882748 - (AZ) LASER SURGERY HOLDING COMPANY LT | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $1595.00 | 1619370434 - SANDPOINT SURGERY CENTER LLC | 465723093 - (ID) SANDPOINT SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $4339.00 | 1902302961 - HILL COUNTRY SURGERY CENTER, LLC, SURGERY CENTER OF BOERNE | 352599588 - (TX) HILL COUNTRY SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $1683.00 | 1881002343 - INNOVATIVE SURGERY CENTER, LLC | 471395981 - (MD) INNOVATIVE SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $1550.00 | 1841298437 - WEST PALM OUTPATIENT SURGERY AND LASER CENTER LTD, NORTHPOINT SURGERY & LASER CENTER | 650592518 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $6285.00 | 1609052679 - BELTWAY SURGERY CENTERS, LLC, BELTWAY SURGERY CENTER SPRINGMILL | 352072586 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $865.00 | 1366651242 - MIAMI VALLEY AMBULATORY SURGERY CENTER LTD | 311559473 | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $4600.00 | 1386882587 - BAYLOR SURGICARE AT GRANBURY LLC, BAYLOR SCOTT & WHITE SURGICARE-GRANBURY | 263896477 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $650.00 | 1093921298 - INDIANA SKIN CANCER AMBULATORY SURGICAL CENTER LLC | 260149227 - (IN) INDIANA SKIN CANCER AMBULATORY SURGICAL CENTER LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $3014.00 | 1962059915 - BRIGHTSIDE SURGICAL, LLC | 831888619 - (ND) BRIGHTSIDE SURGICAL LLC | ND | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $6285.00 | 1861657256 - INDIANA ENDOSCOPY CENTERS LLC | 208398421 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $4293.00 | 1295381572 - SOUTH SUBURBAN SURGICAL SUITES, LLC, SOUTH SUBURBAN SURGICAL SUITES | 842207819 - (IN) SOUTH SUBURBAN SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 35231 | $1770.00 | 1669427043 - VANCOUVER EYE CARE PS | 910913651 - (WA) VANCOUVER EYE CARE, P.S. | WA | 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 35231 vs. Other Surgical Procedures on the Cardiovascular System Codes
The CPT 35231 code is part of the Surgery services used for Surgical Procedures on the Cardiovascular 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 35231 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.
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 35231. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 35231 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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