How much does Medicare pay for CPT 31254?

Medicare allowed an average of $582.71 per service and paid $463.84 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $3459.30, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31254?

Partial removal of nasal sinus using an endoscope. It was billed 2,856 times to 2,575 Medicare beneficiaries by 99 providers in 2024.

Does 31254 pay differently in an office than a hospital?

Yes. The allowed amount averaged $373.26 in an office setting and $914.61 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 31254 most?

Otolaryngology, with 2,118 services from 71 clinicians. Next are Ambulatory Surgical Center.

CPT 31254

Partial removal of nasal sinus using an endoscope

$582.71Medicare-allowed amount per service, averaged across 2,856 services

Providers submitted

$3459.30

Asking price, not received

Medicare allowed

$582.71

The fee schedule figure

Medicare paid

$463.84

Balance is patient coinsurance

Providers submitted an average of $3459.30 for this code and Medicare allowed $582.71 — 5.9× 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 $463.84 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $373.26
Hospital / facility: $914.61

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 1,751 services were billed in an office setting and 1,105 in a facility.

Services: 2,856
Beneficiaries: 2,575
Providers billing it: 99
Total allowed: $1,664,220

What Medicare pays for CPT 31254

Across 2,856 services billed by 99 providers to 2,575 beneficiaries, Medicare allowed an average of $582.71 per service. 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 31254

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	2,118	2,103	$349.21	71
Ambulatory Surgical Center	738	472	$1252.85	28

31254 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	542	$656.93	$376.27	13
Texas	477	$571.36	$348.85	15
Arizona	450	$542.88	$306.02	7
Florida	238	$501.70	$292.66	10
Alabama	155	$485.81	$377.79	5
New York	129	$405.73	$145.31	5
Virginia	85	$334.67	$142.92	1
Kansas	84	$647.93	$488.94	3
Maryland	72	$1134.62	$937.22	4
Indiana	70	$853.56	$672.31	4
Mississippi	66	$929.43	$830.39	3
South Carolina	64	$719.63	$568.58	4
Georgia	51	$716.88	$554.54	3
Nevada	50	$338.05	$129.54	2
Ohio	41	$230.88	$119.44	3
Illinois	37	$373.48	$150.13	3
North Carolina	32	$310.04	$139.31	2
Oregon	25	$307.58	$125.41	1
Oklahoma	24	$214.58	$117.04	1
Louisiana	22	$213.42	$99.22	1
Wisconsin	21	$1269.77	$944.91	1
Wyoming	20	$1491.69	$1217.62	1
Utah	20	$1359.28	$1127.41	1
Montana	18	$208.08	$87.64	1
Pennsylvania	16	$436.66	$253.89	1
Michigan	13	$388.85	$146.62	1
Iowa	12	$304.62	$141.72	1
Arkansas	11	$262.61	$166.08	1
Nebraska	11	$213.35	$112.82	1

Related codes

31231Diagnostic exam of nasal passages$169.68
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
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.