How much does Medicare pay for CPT 31237?

Medicare allowed an average of $327.59 per service and paid $255.74 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1350.48, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31237?

Biopsy or removal of nasal polyp or tissue using an endoscope. It was billed 55,540 times to 30,996 Medicare beneficiaries by 1,200 providers in 2024.

Does 31237 pay differently in an office than a hospital?

Yes. The allowed amount averaged $338.14 in an office setting and $221.33 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 31237 most?

Otolaryngology, with 52,714 services from 1,116 clinicians. Next are Physician Assistant, Nurse Practitioner, Ambulatory Surgical Center.

CPT 31237

Biopsy or removal of nasal polyp or tissue using an endoscope

$327.59Medicare-allowed amount per service, averaged across 55,540 services

Providers submitted

$1350.48

Asking price, not received

Medicare allowed

$327.59

The fee schedule figure

Medicare paid

$255.74

Balance is patient coinsurance

Providers submitted an average of $1350.48 for this code and Medicare allowed $327.59 — 4.1× 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 $255.74 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $338.14
Hospital / facility: $221.33

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. 50,524 services were billed in an office setting and 5,016 in a facility.

Services: 55,540
Beneficiaries: 30,996
Providers billing it: 1,200
Total allowed: $18,194,349

What Medicare pays for CPT 31237

Across 55,540 services billed by 1,200 providers to 30,996 beneficiaries, Medicare allowed an average of $327.59 per service. That is 1.8 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 31237

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	52,714	28,977	$328.17	1,116
Physician Assistant	1,527	1,153	$288.76	44
Nurse Practitioner	878	662	$287.30	31
Ambulatory Surgical Center	183	56	$668.07	2
Ophthalmology	113	79	$353.95	2
Plastic and Reconstructive Surgery	76	28	$319.57	2
Pain Management	20	16	$347.03	1
General Surgery	15	12	$275.63	1
Osteopathic Manipulative Medicine	14	13	$309.16	1

31237 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
Florida	7,142	$339.02	$260.39	137
California	6,329	$352.61	$249.32	120
Texas	6,253	$341.92	$271.84	126
New York	3,064	$377.17	$256.72	57
Arizona	2,871	$318.17	$255.91	42
Illinois	2,237	$351.32	$262.88	39
Pennsylvania	2,155	$291.72	$226.24	45
Georgia	1,653	$340.91	$268.07	42
Tennessee	1,412	$291.47	$245.71	37
North Carolina	1,375	$305.11	$244.24	37
Alabama	1,339	$275.70	$245.30	27
Washington	1,328	$318.72	$236.67	24
Kansas	1,326	$308.18	$267.72	29
New Jersey	1,273	$375.00	$261.77	22
South Carolina	1,178	$289.90	$248.36	33
Massachusetts	1,150	$289.96	$204.46	25
Maryland	1,079	$349.08	$261.08	28
Wisconsin	1,048	$306.33	$250.35	12
Ohio	984	$289.75	$240.67	24
Louisiana	949	$295.55	$252.77	27
Indiana	866	$309.27	$266.32	29
Virginia	821	$315.88	$240.59	21
Oklahoma	738	$318.03	$266.36	14
Mississippi	664	$286.09	$256.65	17
Nevada	656	$326.68	$259.61	13
Missouri	590	$317.62	$258.41	19
Minnesota	538	$326.22	$264.34	14
Colorado	504	$329.64	$254.47	15
Nebraska	453	$257.11	$221.92	17
Kentucky	452	$315.66	$268.52	10
Oregon	446	$285.54	$219.20	11
Connecticut	364	$355.88	$263.39	9
Michigan	339	$312.03	$245.69	14
Iowa	296	$294.99	$251.63	11
Delaware	277	$282.09	$215.71	6
Montana	235	$338.47	$262.01	5
Utah	215	$310.97	$260.54	10
Arkansas	165	$266.16	$231.12	6
Idaho	134	$311.48	$270.64	4
South Dakota	129	$332.62	$267.52	5
Maine	118	$283.33	$218.66	4
District of Columbia	98	$380.68	$254.71	2
Hawaii	83	$276.68	$210.79	3
Puerto Rico	40	$342.41	$266.32	1
Vermont	40	$150.51	$117.63	1
Wyoming	37	$296.56	$269.02	2
New Mexico	28	$299.83	$261.94	1
Alaska	25	$400.34	$251.05	1
New Hampshire	23	$201.47	$151.61	1
North Dakota	21	$162.68	$124.01	1

Related codes

31231Diagnostic exam of nasal passages$169.68
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.