How much does Medicare pay for CPT 31276?

Medicare allowed an average of $1053.25 per service and paid $838.77 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $5614.70, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31276?

Exploration of nasal sinus using an endoscope. It was billed 3,422 times to 2,653 Medicare beneficiaries by 166 providers in 2024.

Which specialty bills 31276 most?

Ambulatory Surgical Center, with 1,775 services from 61 clinicians. Next are Otolaryngology, Ophthalmology, Plastic and Reconstructive Surgery.

CPT 31276

Exploration of nasal sinus using an endoscope

$1053.25Medicare-allowed amount per service, averaged across 3,422 services

Providers submitted

$5614.70

Asking price, not received

Medicare allowed

$1053.25

The fee schedule figure

Medicare paid

$838.77

Balance is patient coinsurance

Providers submitted an average of $5614.70 for this code and Medicare allowed $1053.25 — 5.3× 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 $838.77 (80%); the rest is the patient’s coinsurance and deductible.

Services: 3,422
Beneficiaries: 2,653
Providers billing it: 166
Total allowed: $3,604,222

What Medicare pays for CPT 31276

Across 3,422 services billed by 166 providers to 2,653 beneficiaries, Medicare allowed an average of $1053.25 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 31276

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	1,775	1,017	$1632.21	61
Otolaryngology	1,619	1,608	$428.86	103
Ophthalmology	14	14	$496.79	1
Plastic and Reconstructive Surgery	14	14	$412.48	1

31276 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	430	$1066.44	$647.54	21
Florida	361	$1014.98	$744.24	17
Texas	325	$1321.73	$1065.15	15
Kansas	285	$1194.31	$953.14	10
Tennessee	172	$1148.71	$967.10	9
South Carolina	135	$1093.08	$901.60	6
North Carolina	129	$1055.49	$875.05	7
Pennsylvania	124	$453.39	$191.04	6
Arizona	124	$1083.83	$834.82	6
Maryland	102	$1157.14	$905.05	5
Washington	101	$1095.40	$792.63	5
Mississippi	79	$1087.32	$972.40	4
Alabama	79	$1129.26	$1079.31	4
New York	75	$458.44	$194.87	4
Delaware	74	$1294.77	$952.75	3
Nebraska	70	$989.10	$731.19	4
Montana	68	$1049.40	$794.86	2
Utah	61	$1601.38	$1330.73	2
Georgia	51	$1364.93	$1202.57	2
Oregon	48	$1438.82	$984.78	2
Minnesota	47	$1022.72	$715.13	3
Colorado	46	$987.03	$658.56	3
Indiana	44	$942.62	$709.79	2
Oklahoma	43	$414.88	$218.12	2
New Jersey	40	$412.79	$168.77	2
Idaho	39	$1115.65	$860.40	2
Illinois	36	$1178.39	$863.96	2
Louisiana	34	$408.85	$187.08	2
Virginia	34	$1091.51	$817.74	2
Massachusetts	33	$453.01	$166.53	2
Ohio	31	$1210.93	$936.22	2
Michigan	25	$418.26	$165.31	2
Kentucky	19	$1739.96	$1471.59	1
Connecticut	12	$470.49	$172.16	1
Nevada	12	$378.97	$155.58	1
New Hampshire	12	$418.93	$166.67	1
Wisconsin	11	$457.89	$198.69	1
Missouri	11	$360.37	$177.13	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
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.