Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)

CPT 31237 is the billing code for "Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)". Surgical nasal/sinus endoscopy with biopsy, polypectomy, or debridement

Medicare pays approximately $257.48 for CPT 31237 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 31237 has a total RVU of 4.36, broken down as: Work RVU 2.00, Practice Expense RVU 2.20, and Malpractice RVU 0.16. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 31237 include: Surgical procedure performed documented; Biopsy/polypectomy/debridement documented; Findings documented; Patient response to procedure. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 31237: Surgical endoscopy. Includes biopsy, polypectomy, or debridement Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 31237 include: 59 (Distinct procedural service when multiple procedures performed), 50 (Bilateral procedure), LT (Left side). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 31237 is Typically 20-30 minutes. Time-based codes require documentation of the actual time spent providing the service.