How much does Medicare pay for CPT 31256?

Medicare allowed an average of $535.88 per service and paid $426.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $4689.50, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31256?

Incision of nasal sinus using an endoscope. It was billed 2,795 times to 2,101 Medicare beneficiaries by 139 providers in 2024.

Which specialty bills 31256 most?

Ambulatory Surgical Center, with 1,717 services from 67 clinicians. Next are Otolaryngology, Ophthalmology.

CPT 31256

Incision of nasal sinus using an endoscope

$535.88Medicare-allowed amount per service, averaged across 2,795 services

Providers submitted

$4689.50

Asking price, not received

Medicare allowed

$535.88

The fee schedule figure

Medicare paid

$426.65

Balance is patient coinsurance

Providers submitted an average of $4689.50 for this code and Medicare allowed $535.88 — 8.8× 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 $426.65 (80%); the rest is the patient’s coinsurance and deductible.

Services: 2,795
Beneficiaries: 2,101
Providers billing it: 139
Total allowed: $1,497,785

What Medicare pays for CPT 31256

Across 2,795 services billed by 139 providers to 2,101 beneficiaries, Medicare allowed an average of $535.88 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 31256

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,717	1,032	$782.39	67
Otolaryngology	1,067	1,058	$142.94	71
Ophthalmology	11	11	$172.15	1

31256 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	321	$511.35	$402.09	15
Texas	263	$559.05	$452.77	12
California	187	$483.28	$292.11	10
Arizona	139	$683.31	$556.78	5
Tennessee	137	$496.46	$424.74	8
Indiana	112	$486.25	$426.05	6
Nebraska	98	$517.95	$396.88	4
Maryland	97	$545.62	$436.64	4
Washington	93	$740.79	$556.26	5
South Carolina	91	$555.87	$473.68	5
Mississippi	88	$582.86	$549.89	4
Virginia	76	$828.75	$682.73	3
Kansas	68	$551.75	$469.34	4
Colorado	67	$660.98	$545.94	3
Alabama	66	$725.54	$660.59	2
New York	66	$244.39	$230.12	5
Minnesota	64	$327.91	$238.68	4
Utah	64	$623.60	$503.30	3
Montana	64	$458.00	$353.08	2
Massachusetts	60	$142.72	$63.68	4
Oklahoma	60	$339.38	$277.27	3
Wisconsin	53	$660.40	$517.01	3
Pennsylvania	53	$141.90	$63.00	3
Wyoming	50	$578.98	$443.86	2
Ohio	46	$445.80	$340.37	3
Louisiana	46	$148.89	$87.01	3
Illinois	46	$615.55	$468.35	2
North Carolina	45	$734.82	$641.34	2
Iowa	38	$797.39	$694.85	2
Idaho	35	$471.75	$362.12	2
Georgia	34	$868.60	$704.36	2
Connecticut	22	$832.52	$641.97	1
Oregon	21	$866.07	$614.04	1
Arkansas	14	$143.87	$80.74	1
Nevada	11	$119.32	$69.38	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
31254Partial removal of nasal sinus$582.71
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.