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CPT 31237: Nasal Endoscopy with Biopsy, Polypectomy, or Debridement

CPT code 31237 represents nasal endoscopy with concurrent minor intranasal surgical interventions such as biopsy, polypectomy, or debridement. This code captures procedures that combine diagnostic visualization of the nasal cavity with targeted tissue removal or sampling and is commonly used by otolaryngology specialists for evaluation and treatment of nasal polyps, sinus disease, and other intranasal disorders. Nationally, accurate coding of procedures like CPT code 31237 matters for clinical documentation, appropriate billing, and alignment with surgical service lines across office, outpatient clinic, and ambulatory surgery settings.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for use of CPT code 31237, common indications and encounter settings, and how it relates to adjacent endoscopic sinus procedures. The publication provides benchmarking and policy-relevant context for coding and service classification, highlights common diagnostic indications tied to the procedure, and explains relationships to related surgical endoscopy codes used for more extensive sinus surgery. The content is intended for coding professionals, practice managers, and clinicians seeking concise guidance on the clinical scope and billing classification of this nasal endoscopy procedure.

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Billing Code Overview

CPT code 31237 describes a diagnostic and minor surgical nasal endoscopy procedure. The provider inserts an endoscope into the nasal cavity to inspect internal nasal structures and then performs focal interventions such as a nasal biopsy, polypectomy, or debridement during the same encounter.

Service Type: Diagnostic endoscopy with minor intranasal surgical intervention

Typical Site of Service: Office or outpatient clinic; may also be performed in ambulatory surgery centers when clinically indicated

National Reimbursement Benchmarks

Medicare’s mean rate of $275.30 sits below BUCA’s average commercial mean of $1,336.70, indicating Medicare reimbursement for CPT 31237 is substantially lower than this commercial benchmark. The gap of $1,061.40 between those means highlights material differences in payer economics for this procedure, with Medicare clustering near the lower end of national reimbursements while BUCA reflects a higher commercial average.

Looking at dispersion using P75 minus P25, Blue Cross Blue Shield shows a wide spread of $2,441.40 (P75 $2,996.40 minus P25 $530.50), followed by BUCA with $1,522.60 (P75 $1,910.10 minus P25 $387.50) and UnitedHealth Group with $244.40 (P75 $493.30 minus P25 $245.90). Aetna and Cigna exhibit tighter spreads of $284.00 and $219.10 respectively, indicating more concentrated reimbursement ranges for those payers.

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CPT 31237: Nasal Endoscopy with Biopsy, Polypectomy, or Debridement

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Billing Code Overview

Service Type: Diagnostic endoscopy with minor intranasal surgical intervention

Typical Site of Service: Office or outpatient clinic; may also be performed in ambulatory surgery centers when clinically indicated

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 45-year-old patient presents to an otolaryngology clinic with several months of unilateral nasal obstruction, intermittent epistaxis, and reduced sense of smell. Anterior rhinoscopy suggests a polypoid mass in the middle meatus. Prior medical therapy with intranasal corticosteroids provided partial relief. The otolaryngologist schedules an in-office diagnostic and limited therapeutic nasal endoscopy under local anesthesia. During the visit the provider inserts a nasal endoscope (CPT 31237) to inspect the nasal cavity, documents the polypoid lesion and adjacent mucosal inflammation, and performs a targeted biopsy of the mass. If feasible in the same session, the provider performs limited polypectomy and debridement of necrotic tissue to improve nasal airflow and obtain tissue for histopathology. Specimens are submitted to pathology. The patient is monitored briefly postprocedure for bleeding and discharged with written aftercare instructions and prescriptions as indicated. Typical site of service is an ambulatory surgical center or office procedure room under otolaryngology care; anesthesia is often local with or without minimal sedation.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a distinct E/M visit is performed and documented on the same date as `31237` (e.g., new problem evaluation prior to endoscopy).

59 | Distinct procedural service | Use to indicate a separate, distinct procedural service when another non-overlapping procedure is billed on the same date.

52 | Reduced services | Use when the endoscopic procedure is partially reduced or not completed as originally intended.

53 | Discontinued procedure | Use when the procedure was started but terminated due to extenuating circumstances or patient safety.

50 | Bilateral procedure | Use when the same endoscopic procedure is performed on both nostrils and payer requires bilateral modifier reporting.

51 | Multiple procedures | Use when multiple unrelated procedures are performed in the same session and carrier rules permit reduced payment for secondary procedures.

22 | Increased procedural service | Use when documentation supports substantially greater work than usual for 31237 (e.g., extensive intra-nasal adhesions requiring additional operative time).

26 | Professional component | Use when billing only the professional component and technical component is billed separately by another entity.

TC | Technical component | Use when billing only the technical component (facility resources, equipment) and the physician bills separately for professional work.

74 | Return to operating room for a related procedure during the postoperative period (unplanned, after anesthesia recovery) | Use when a related corrective procedure occurs the same day after initial recovery and payer accepts modifier 74 for the circumstance.

79 | Unrelated procedure or service by the same physician during the postoperative period | Use when an unrelated procedure is performed during the global period.

76 | Repeat procedure or service by same physician | Use when the same endoscopic service is repeated later the same day by the same physician.

77 | Repeat procedure by another physician | Use when the same procedure is repeated by a different physician (note: not present in original list; exclude).

62 | Two surgeons | Use when two surgeons with different specialties perform distinct parts of the procedure (e.g., combined endoscopic sinonasal and skull base cases) — apply only if payer allows.

Taxonomy Code	Specialty	Notes
`207Y00000X`	Otolaryngology Physician	Primary specialty performing nasal endoscopy and related surgical procedures.

207YX0602X | Otolaryngology/Facial Plastic Surgery | Procedures involving concurrent nasal valve, cosmetic, or reconstructive considerations.

207YS0123X | Otolaryngology/Plastic Surgery within the Head & Neck | Relevant when combined sinonasal and head/neck reconstructive procedures are performed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J33.0`	Polyp of nasal cavity	Nasal polyps are a common indication for nasal endoscopy with biopsy or polypectomy to relieve obstruction and obtain histology.

J32.9 | Chronic sinusitis, unspecified | Chronic sinonasal inflammation may require endoscopic evaluation with debridement or limited surgical intervention when medical therapy fails.

J34.2 | Deviated nasal septum | Septal deviation can contribute to obstruction and may be assessed during endoscopy; concurrent procedures (septoplasty) may be planned.

J01.90 | Acute sinusitis, unspecified | Acute infectious exacerbations can prompt diagnostic endoscopy and targeted debridement or culture-guided biopsy in complicated cases.

J34.89 | Other specified disorders of nose and nasal sinuses | Miscellaneous anatomic or inflammatory nasal conditions requiring diagnostic endoscopy and targeted tissue removal or biopsy.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31238`	Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage	Used when endoscopic inspection is followed by active control of bleeding rather than biopsy or polypectomy.

31254 | Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) | Performed when disease extends into the ethmoid sinuses and more extensive surgical removal is required beyond limited polypectomy.

31255 | Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) | Used for more extensive ethmoid disease requiring anterior and posterior ethmoidectomy during the same operative session.

31256 | Nasal/sinus endoscopy, surgical; with maxillary antrostomy | Performed if maxillary sinus drainage pathways are opened due to chronic maxillary sinus disease encountered during endoscopy.

31267 | Nasal/sinus endoscopy, surgical; with removal of tissue from maxillary sinus | Used when the surgical plan includes debridement or removal of diseased tissue specifically from the maxillary sinus.

31276 | Nasal/sinus endoscopy, surgical; with frontal sinus exploration, with or without removal of tissue from frontal sinus | Applied when disease involves frontal sinus requiring exploration or tissue removal beyond a simple nasal polypectomy.

31287 | Nasal/sinus endoscopy, surgical, with sphenoidotomy | Used when sphenoid sinus intervention is required in addition to diagnostic/limited therapeutic endoscopy.

31288 | Nasal/sinus endoscopy, surgical; with removal of tissue from the sphenoid sinus | Performed when tissue removal from the sphenoid sinus is undertaken in the same operative setting.

CPT 31231: Diagnostic Nasal Endoscopy of Nasal Cavity

CPT-31233-MAXILLARY-SINUS-DIAGNOSTIC-ENDOSCOPY-THROUGH-CANINE-FOSSA-OR-INFERIOR-MEATUS

CPT 31233: Diagnostic Endoscopic Access to Maxillary Sinus

CPT-31235-SPHENOID-SINUS-DIAGNOSTIC-ENDOSCOPY

CPT 31235: Diagnostic Endoscopy of the Sphenoid Sinus

CPT-31238-ENDOSCOPIC-NASAL-HEMOSTASIS

CPT 31238: Endoscopic Nasal Hemostasis

CPT-31239-DACRYOCYSTORHINOSTOMY-EXTERNAL-DCR

CPT 31239: Dacryocystorhinostomy (External)

CPT-31240-ENDOSCOPIC-CONCHA-BULLOSA-REMOVAL

CPT 31240: Endoscopic Intranasal Procedure for Concha Bullosa Removal

CPT-31241-ENDOSCOPIC-SPHENOPALATINE-ARTERY-LIGATION-NASAL

CPT 31241: Endoscopic Sphenopalatine Artery Ligation for Epistaxis

CPT-31242-POSTERIOR-NASAL-NERVE-RADIOFREQUENCY-ABLATION-ENDOSCOPIC

CPT 31242: Endoscopic Posterior Nasal Nerve Radiofrequency Ablation

CPT-31243-POSTERIOR-NASAL-NERVE-CRYOABLATION-ENDOSCOPIC

CPT 31243: Endoscopic Cryoablation of Posterior Nasal Nerve

CPT-31253-ETHMOID-EXCISION-WITH-FRONTAL-SINUS-EXPLORATION

CPT 31253: Ethmoid Excision with Frontal Sinus Exploration

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References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure	Use when a distinct E/M visit is performed and documented on the same date as `31237` (e.g., new problem evaluation prior to endoscopy).