Summary & Overview
CPT 31231: Diagnostic Nasal Endoscopy, Unilateral or Bilateral
CPT code 31231 is a widely utilized billing code for diagnostic nasal endoscopy procedures performed by otolaryngology specialists. This code covers both unilateral and bilateral examinations, enabling clinicians to directly visualize the nasal passages and sinuses for diagnostic purposes. The procedure is most often conducted in an office setting, supporting timely evaluation and management of conditions such as chronic sinusitis, nasal congestion, and nasal polyps.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare recognize and reimburse for CPT code 31231. The publication provides an overview of payer coverage, clinical indications, and relevant coding practices, including common modifiers used to specify laterality and distinct procedural services. Readers will gain insight into the clinical context for nasal endoscopy, associated diagnoses, and related CPT codes, as well as current policy updates and reimbursement benchmarks. The analysis is designed to inform stakeholders about the utilization and billing landscape for diagnostic nasal endoscopy across the United States.
CPT Code Overview
CPT code 31231 represents a diagnostic nasal endoscopy, performed unilaterally or bilaterally as a separate procedure. This service is commonly provided by otolaryngology specialists to evaluate the nasal passages and sinuses for a range of conditions. The typical site of service for this procedure is the office setting (Place of Service 11), allowing for efficient assessment and management of nasal and sinus disorders in an outpatient environment.
Clinical & Coding Specifications
Clinical Context
A patient presents to an otolaryngology office with symptoms such as nasal congestion, sinus pain, or suspected nasal polyps. The provider performs a diagnostic nasal endoscopy (CPT 31231) to directly visualize the nasal passages and sinuses. This procedure may be done unilaterally or bilaterally, depending on the clinical findings. The workflow typically includes patient history, physical examination, and the endoscopic procedure to assess for conditions like chronic or acute sinusitis, nasal polyps, or other nasal disorders.
Coding Specifications
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Modifiers:
50- Bilateral Procedure: Used when the endoscopy is performed on both sides.RT- Right Side: Used when the procedure is performed only on the right nasal passage.LT- Left Side: Used when the procedure is performed only on the left nasal passage.59- Distinct Procedural Service: Used when the procedure is distinct from other services performed on the same day.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207Y00000X | Otolaryngology Physician |
207YX0007X | Otolaryngology/Facial Plastic Surgery |
207YX0602X | Otolaryngology/Plastic Surgery within the Head & Neck |
These taxonomies represent providers specializing in otolaryngology and related subspecialties.
Related Diagnoses
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J32.9- Chronic sinusitis, unspecified- Relevant for patients with persistent sinus symptoms requiring endoscopic evaluation.
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J34.89- Other specified disorders of nose and nasal sinuses- Used for less common nasal or sinus disorders that warrant endoscopic assessment.
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R09.81- Nasal congestion- Indicates patients presenting with nasal blockage, often evaluated by endoscopy.
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J01.90- Acute sinusitis, unspecified- For patients with acute sinus infection symptoms needing diagnostic visualization.
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J33.0- Polyp of nasal cavity- Used when nasal polyps are suspected or identified during endoscopy.
Related CPT Codes
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31233- Nasal/sinus endoscopy, diagnostic: This code represents a diagnostic endoscopy of the nasal or sinus passages, similar to31231, but may be used for more extensive evaluation. -
31235- Nasal/sinus endoscopy, diagnostic: Also a diagnostic endoscopy code, often used in conjunction with or as an alternative to31231depending on the clinical scenario.
These codes are related to 31231 and may be used together or as alternatives when a more comprehensive endoscopic evaluation is required.
National Reimbursement Benchmarks
For CPT code 31231, the national mean rate for Medicare is $201.00, while the average commercial benchmark (BUCA) is $186.49. Commercial payers such as UnitedHealth Group and Cigna have notably higher mean rates, with UnitedHealth Group at $257.24 and Cigna at $233.96, compared to both Medicare and BUCA.
Rate dispersion varies significantly across payers. Medicare shows the tightest range between the 25th and 75th percentiles ($24.00), indicating relatively consistent reimbursement. In contrast, UnitedHealth Group exhibits the widest spread ($133.08), followed by Cigna ($130.00), reflecting greater variability in commercial rates. The table and chart below present the full breakdown of national benchmarks for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.