How much does Medicare pay for CPT 31231?

Medicare allowed an average of $169.68 per service and paid $127.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $543.80, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31231?

Diagnostic exam of nasal passages using an endoscope. It was billed 718,711 times to 535,317 Medicare beneficiaries by 6,468 providers in 2024.

Does 31231 pay differently in an office than a hospital?

Yes. The allowed amount averaged $185.73 in an office setting and $46.64 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 31231 most?

Otolaryngology, with 637,406 services from 5,179 clinicians. Next are Physician Assistant, Nurse Practitioner, Allergy/ Immunology.

CPT 31231

Diagnostic exam of nasal passages using an endoscope

$169.68Medicare-allowed amount per service, averaged across 718,711 services

Providers submitted

$543.80

Asking price, not received

Medicare allowed

$169.68

The fee schedule figure

Medicare paid

$127.85

Balance is patient coinsurance

Providers submitted an average of $543.80 for this code and Medicare allowed $169.68 — 3.2× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $127.85 (75%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $185.73
Hospital / facility: $46.64

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 635,778 services were billed in an office setting and 82,933 in a facility.

Services: 718,711
Beneficiaries: 535,317
Providers billing it: 6,468
Total allowed: $121,950,882

What Medicare pays for CPT 31231

Across 718,711 services billed by 6,468 providers to 535,317 beneficiaries, Medicare allowed an average of $169.68 per service. That is 1.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 31231

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	637,406	467,586	$173.99	5,179
Physician Assistant	47,827	40,351	$128.69	737
Nurse Practitioner	24,103	19,997	$132.72	396
Allergy/ Immunology	2,607	2,025	$187.29	40
Ophthalmology	2,100	1,651	$148.79	53
Plastic and Reconstructive Surgery	1,304	975	$175.93	20
General Surgery	1,097	827	$202.83	5
Internal Medicine	835	699	$204.70	17
Family Practice	309	288	$188.37	4
Osteopathic Manipulative Medicine	267	198	$172.09	2
Pain Management	206	172	$206.42	1
Pulmonary Disease	187	177	$219.18	4
General Practice	145	93	$211.84	2
Emergency Medicine	115	100	$209.17	1
Sleep Medicine	71	71	$74.31	2

31231 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	117,674	$128.84	$87.21	554
New York	96,800	$211.52	$134.11	522
Florida	94,375	$179.66	$135.28	542
Texas	39,832	$165.35	$127.72	468
New Jersey	38,859	$207.85	$135.59	238
Pennsylvania	38,054	$167.53	$123.57	327
Illinois	23,715	$168.26	$122.64	260
Massachusetts	23,683	$175.37	$119.01	186
Maryland	17,968	$194.22	$137.37	138
Georgia	17,308	$172.80	$131.07	234
Arizona	16,234	$167.84	$131.13	129
South Carolina	15,107	$158.96	$129.21	143
North Carolina	14,313	$162.75	$127.02	202
Virginia	13,911	$170.18	$127.11	182
Ohio	11,562	$137.88	$111.70	189
Colorado	9,086	$169.81	$124.12	141
Tennessee	8,472	$149.59	$124.93	130
Connecticut	7,987	$192.88	$134.77	94
Washington	7,865	$166.43	$116.48	129
Michigan	7,440	$155.94	$118.54	150
Indiana	6,847	$164.03	$132.98	100
Alabama	6,422	$147.98	$126.79	87
Louisiana	6,251	$156.19	$128.24	100
Missouri	5,698	$158.54	$125.68	103
Kentucky	5,674	$161.81	$136.15	78
Kansas	5,575	$161.05	$132.37	67
Iowa	5,287	$149.76	$119.71	73
Minnesota	5,006	$170.31	$127.14	108
Oregon	4,860	$162.37	$120.45	87
Wisconsin	4,744	$136.46	$104.22	114
Nebraska	4,267	$142.22	$115.36	58
Oklahoma	4,126	$163.19	$132.49	57
Nevada	3,493	$165.09	$129.45	25
Mississippi	3,201	$152.40	$130.21	45
Delaware	2,932	$167.23	$126.61	19
Hawaii	2,735	$185.20	$131.57	16
District of Columbia	2,343	$201.94	$140.31	16
Arkansas	2,299	$155.12	$131.13	34
Utah	2,131	$148.03	$117.15	49
Montana	1,985	$163.39	$118.48	29
New Mexico	1,638	$125.51	$101.77	32
New Hampshire	1,428	$116.51	$83.54	36
Idaho	1,390	$138.12	$114.70	28
South Dakota	1,348	$148.52	$114.59	22
Maine	1,304	$156.67	$116.08	20
West Virginia	1,201	$135.14	$107.71	26
Rhode Island	1,075	$184.76	$137.94	13
Puerto Rico	860	$182.65	$131.37	19
North Dakota	691	$100.48	$79.09	17
Wyoming	537	$174.85	$132.69	11
Alaska	508	$192.22	$126.26	10
Vermont	505	$60.11	$46.25	7
U.S. Virgin Islands	50	$172.91	$129.71	2
AP	39	$168.94	$124.63	1
ZZ	16	$160.66	$122.88	1

Related codes

31237Biopsy or removal of nasal polyp or tissue$327.59
31295Dilation of nasal sinus$1974.90
31267Removal of nasal sinus tissue$951.39
31238Control of bleeding of nose$260.10
31298Dilation of sphenoid and frontal nasal sinus$4271.74
31276Exploration of nasal sinus$1053.25
31233Exam of nasal passage and sinus$337.56
31254Partial removal of nasal sinus$582.71
31256Incision of nasal sinus$535.88
31242Destruction of nasal nerve by heat$2439.75
31296Dilation of frontal nasal sinus$1854.89
31259Removal of tissue from sphenoid sinus$850.44

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.