CPT 67031 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 Eye and Ocular Adnexa |
| Common Place of Service | • 11 - Office • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • RT - Right side of body • LT - Left side of body |
| Complexity Level | Moderate |
National average reimbursement for CPT 67031 by major payers:
$494.44
$493.92
$518.41
$635.34
| 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 67031 | ||||||
United | 67031 | $730.00 | 1477516532 - SPECIALTY SURGICARE OF LAS VEGAS, LP | 260116160 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $197.00 | 1538154604 - PAIN MANAGEMENT & SURGERY CENTER OF SOUTHERN INDIANA | 351972676 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $1553.00 | 1851029060 - COLORADO SPRINGS SURGICENTER, LLC | 862813124 - COLORADO SPRINGS SURGICENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $234.00 | 1356654610 - ENDO-SURGICAL CENTER OF FLORIDA | 272047909 - (FL) ENDOSURGICAL CENTER OF FLORIDA | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $920.00 | 1063058303 - CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH, LLC | 843621271 - (VA) CHESAPEAKE REGIONAL SURGERY CENTER AT VIRGINIA BEACH LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $598.00 | 1962455428 - VALLEY EYE INSTITUTE ASC LLC, CVP SURGERY CENTER | 200080762 - (OH) VALLEY EYE INSTITUTE ASC LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $1033.00 | 1174708390 - ORTHOPAEDIC SPECIALTY SURGERY CENTER LLC, ORTHOPAEDIC & SPECIALTY SURGERY CENTER | 263119034 - (CT) ORTHOPAEDIC SPECIALTY SURGERY CENTER, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $773.00 | 1043746555 - OVERLAND PARK SURGICAL SUITES, LLC | 814367607 - (KS) OVERLAND PARK SURGICAL SUITES LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $415.00 | 1457335077 - DENVER EYE SURGERY CENTER, LLC | 840974806 - (CO) DENVER EYE SURGERY CENTER LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $592.00 | 1629517800 - NORTHWEST SURGERY CENTER, LLC | 813834496 - (CO) NORTHWEST SURGERY CENTER, LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $347.00 | 1952535502 - PLATEAU SURGERY CENTER | 264769256 - (TN) PLATEAU SURGERY CENTER | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $382.00 | 1508857871 - MANATEE SURGICAL CENTER, LLC | 650826479 - (FL) MANATEE SURGICAL CENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $385.00 | 1801827993 - SOUTH CAROLINA ENDOSCOPY CENTER | 571125931 - (SC) SOUTH CAROLINA ENDOSCOPY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $384.00 | 1629045133 - MONTICELLO COMMUNITY SURGERY CENTER, LLC, UVA HEALTH SURGICAL CARE RIVERSIDE | 113656095 - (VA) MONTICELLO COMMUNITY SURGERY | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 67031 | $249.00 | 1124296173 - TREASURE COAST SURGICAL CENTER INC | 260770428 - (FL) TREASURE COAST 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 67031 vs. Other Surgical Procedures on the Eye and Ocular Adnexa Codes
The CPT 67031 code is part of the Surgery services used for Surgical Procedures on the Eye and Ocular Adnexa. 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 67031 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 |
|---|---|---|
| 67030-CPT | Moderate | Discission Vitreous Strands Pars Plana A |
| 67031-CPT | Moderate | Severing Of Vitreous Strands, Vitreous Face Adhesions, Sheets, Membranes Or Opacities, Laser Surgery (One Or More Stag |
| 67036-CPT | High | Vitrectomy Mechan Pars Plana Appr |
| 67039-CPT | High | Vitrect. W Focal Endolaser Photocoag. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 67031. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 67031 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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