HCPCS 31231

Procedure (ClaimLight category; the code descriptor is not shown)

Procedures Work RVU per service 1.10 (2020 fee schedule)

5,360
95th percentile among 6,116 codes billed · 2020
$65M
97th percentile among 6,116 codes billed · 2020
455K
93rd percentile among 6,116 codes billed · 2020
44
73rd percentile among 6,116 codes billed · 2020
272
74th percentile among 6,116 codes billed · 2020

Trend

Medicare payment on the code

$0$50M$100M2020: $65M paid20202021: $80M paid20212022: $83M paid20222023: $90M paid20232024: $92M paid2024$92M$0$50M$100M2020: $65M paid20202021: $80M paid20212022: $83M paid20222023: $90M paid20232024: $92M paid2024$92M$0$50M$100M2020: $65M paid20202021: $80M paid20212022: $83M paid20222023: $90M paid20232024: $92M paid2024$92M$0$50M$100M2020: $65M paid20202021: $80M paid20212022: $83M paid20222023: $90M paid20232024: $92M paid2024$92M

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

Billers

02,5005,0002020: 5,360 providers20202021: 5,669 providers20212022: 5,908 providers20222023: 6,206 providers20232024: 6,468 providers20246,46802,5005,0002020: 5,360 providers20202021: 5,669 providers20212022: 5,908 providers20222023: 6,206 providers20232024: 6,468 providers20246,46802,5005,0002020: 5,360 providers20202021: 5,669 providers20212022: 5,908 providers20222023: 6,206 providers20232024: 6,468 providers20246,46802,5005,0002020: 5,360 providers20202021: 5,669 providers20212022: 5,908 providers20222023: 6,206 providers20232024: 6,468 providers20246,468

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

observed calculated calculated calculated calculated calculated reported
20246,468$91,885,094+2%718,711543601.10
20236,206$89,697,216+8%668,637533541.10
20225,908$83,358,923+4%603,894523311.10
20215,669$80,380,280+24%544,873493121.10
20205,360$64,591,268first year in data455,244442721.10

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Data years 2020–2024.

By state

observed calculated calculated calculated calculated calculated
New York493$11,081,97363,33273406
Florida446$9,626,99266,31576551
California445$6,808,20853,90653366
New Jersey218$3,835,66522,71073309
Texas399$3,357,51624,07237174
Pennsylvania273$3,308,75324,46048281
Illinois191$1,948,00414,63843276
Massachusetts166$1,928,04913,78347239
Maryland119$1,897,00412,02656322
Georgia203$1,872,83813,77844175
Arizona115$1,467,45810,63559302
North Carolina174$1,378,81411,06741183
Virginia147$1,371,8249,80237200
South Carolina111$1,229,1699,56560257
Connecticut79$900,3165,56446189

Not listed: 1 billers with an armed-forces or unknown state code (AP); they are in the national totals.

Not listed: 4 states with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Providers placed by practice address. Data year 2020.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ536$13,262,49374,96897
Los Angeles-Long Beach-Anaheim, CA165$3,150,87429,96761
Miami-Fort Lauderdale-West Palm Beach, FL128$3,118,32420,41385
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD159$2,499,24017,94369
Chicago-Naperville-Elgin, IL-IN155$2,155,97115,74748
Boston-Cambridge-Newton, MA-NH130$1,654,87611,84658
Atlanta-Sandy Springs-Roswell, GA130$1,326,8739,50447
Baltimore-Columbia-Towson, MD60$1,231,0197,947102
Washington-Arlington-Alexandria, DC-VA-MD-WV109$1,224,7877,24933
Houston-Pasadena-The Woodlands, TX116$1,201,7458,14840
Tampa-St. Petersburg-Clearwater, FL73$974,2297,02253
Jacksonville, FL41$917,1116,60063
Phoenix-Mesa-Chandler, AZ74$791,5645,76350
San Diego-Chula Vista-Carlsbad, CA52$730,0804,68662
San Francisco-Oakland-Fremont, CA61$683,1294,18044

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 81 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2020.

Specialties billing 31231 nationally

Otolaryngology accounts for 94% of payment for 31231 nationally in 2020, across 7 specialties on claims.

observed calculated calculated calculated calculated calculated
Otolaryngology4,73288%$60,938,37894%423,51790
Physician Assistant2965.5%$1,490,8612.3%14,98751
Nurse Practitioner1903.5%$1,040,7341.6%9,25349
Ophthalmology450.84%$307,1910.48%2,32752
Allergy/ Immunology370.69%$261,7530.41%1,63844
Internal Medicine180.34%$164,0250.25%98855
Plastic and Reconstructive Surgery110.21%$96,8480.15%68162

Not listed: 11 specialties with fewer than 11 billers (small cells).

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). Provider-level lines (fewer than 11 beneficiaries suppressed by CMS); specialty is the provider type on claims. Data year 2020.

Top billers of 31231 nationally

Named top billers are a Pro figure, and Pro is not available to buy, so this list is not shown to any account. The counts and totals by state, metro area and specialty on this page are free.

Original Medicare Part B fee-for-service only; CMS suppresses provider lines with fewer than 11 beneficiaries. How these figures are computed · Limitations