How much does Medicare pay for CPT 31615?

Medicare allowed an average of $145.91 per service and paid $114.01 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $535.58, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 31615?

Exam of windpipe and lung airways through permanent windpipe opening using an endoscope. It was billed 3,260 times to 1,529 Medicare beneficiaries by 74 providers in 2024.

Does 31615 pay differently in an office than a hospital?

Yes. The allowed amount averaged $173.95 in an office setting and $109.66 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 31615 most?

Otolaryngology, with 2,893 services from 61 clinicians. Next are Nurse Practitioner, Pulmonary Disease, Plastic and Reconstructive Surgery.

CPT 31615

Exam of windpipe and lung airways through permanent windpipe opening using an endoscope

$145.91Medicare-allowed amount per service, averaged across 3,260 services

Providers submitted

$535.58

Asking price, not received

Medicare allowed

$145.91

The fee schedule figure

Medicare paid

$114.01

Balance is patient coinsurance

Providers submitted an average of $535.58 for this code and Medicare allowed $145.91 — 3.7× 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 $114.01 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $173.95
Hospital / facility: $109.66

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. 1,838 services were billed in an office setting and 1,422 in a facility.

Services: 3,260
Beneficiaries: 1,529
Providers billing it: 74
Total allowed: $475,667

What Medicare pays for CPT 31615

Across 3,260 services billed by 74 providers to 1,529 beneficiaries, Medicare allowed an average of $145.91 per service. That is 2.1 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 31615

Specialty	Services	Beneficiaries	Avg allowed	Providers
Otolaryngology	2,893	1,318	$149.19	61
Nurse Practitioner	217	95	$128.87	5
Pulmonary Disease	57	39	$92.80	3
Plastic and Reconstructive Surgery	30	26	$113.57	1
Physician Assistant	19	13	$92.41	1
Critical Care (Intensivists)	17	14	$119.97	1
General Surgery	15	12	$168.99	1
Thoracic Surgery	12	12	$88.99	1

31615 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
New York	1,014	$185.36	$124.79	8
Pennsylvania	449	$143.76	$106.37	10
Texas	370	$129.58	$100.28	10
California	316	$131.92	$91.93	10
Illinois	242	$132.00	$95.54	5
Maryland	150	$116.95	$84.96	6
North Carolina	113	$106.51	$89.64	1
Louisiana	67	$81.68	$86.20	3
Florida	66	$122.47	$80.66	2
New Jersey	57	$146.56	$104.82	2
Massachusetts	51	$122.32	$82.01	2
South Carolina	49	$133.57	$108.77	2
Michigan	46	$102.70	$74.09	2
Minnesota	37	$166.99	$118.26	1
Ohio	35	$98.23	$82.88	1
Tennessee	29	$152.39	$112.69	1
Mississippi	24	$104.65	$88.29	1
Missouri	24	$149.51	$138.92	1
Nebraska	23	$103.39	$86.33	1
Alabama	21	$101.25	$87.94	1
Iowa	21	$102.09	$87.12	1
Georgia	20	$108.63	$84.26	1
Kansas	19	$92.41	$75.32	1
Oregon	17	$109.86	$76.72	1

Related codes

31624Irrigation and suction of lung airways to obtain cells$57.02
31628Biopsy of lobe of lung$77.25
31627Computer-assisted image-guided navigation of lung airways$93.76
31629Needle biopsy of windpipe cartilage$144.37
31645Aspiration of initial secretion of lung airway$83.67
31654Exam of lung airways$64.48
31652Exam of lung airways and sampling of lymph nodes$173.21
31653Exam of lung airways and sampling of lymph nodes$221.80
31622Diagnostic exam of lung airway$108.89
31623Exam of lung airways$15.29
31632Biopsy of lobe of lung$47.23
31625Biopsy of lung airway$72.30

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.