HCPCS 31231

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

Procedures Work RVU per service 1.10 (2021 fee schedule)

5,669
95th percentile among 6,253 codes billed · 2021
$80M
97th percentile among 6,253 codes billed · 2021
545K
93rd percentile among 6,253 codes billed · 2021
49
74th percentile among 6,253 codes billed · 2021
312
76th percentile among 6,253 codes billed · 2021
+24.4%
Medicare payment on the code vs 2020; billers +5.8% · 2021

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 York509$14,337,95477,43388473
Florida471$10,985,08573,08175537
California471$8,823,16070,18161373
New Jersey211$5,075,33428,387101366
Texas417$4,260,71428,96344202
Pennsylvania283$4,136,38529,30556364
Illinois208$2,639,54318,79657287
Massachusetts174$2,617,10718,15252322
Maryland121$2,511,21115,04075368
Georgia207$2,082,20414,77648188
North Carolina186$1,714,66713,00440206
Virginia159$1,696,97911,74240242
Arizona109$1,669,31211,59969287
South Carolina123$1,494,10411,21860296
Connecticut80$1,114,4706,59256226

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 2021.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ535$17,038,57590,787114
Los Angeles-Long Beach-Anaheim, CA177$4,092,14040,70668
Miami-Fort Lauderdale-West Palm Beach, FL145$3,566,98722,62375
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD159$3,392,52523,36096
Chicago-Naperville-Elgin, IL-IN174$2,610,25918,29261
Boston-Cambridge-Newton, MA-NH136$2,268,40615,75062
Houston-Pasadena-The Woodlands, TX123$1,635,78410,55452
Washington-Arlington-Alexandria, DC-VA-MD-WV112$1,628,2339,16138
Baltimore-Columbia-Towson, MD60$1,559,5739,550118
Atlanta-Sandy Springs-Roswell, GA133$1,453,0799,96149
Tampa-St. Petersburg-Clearwater, FL73$1,194,9048,21675
Phoenix-Mesa-Chandler, AZ74$1,073,9237,50666
Jacksonville, FL41$1,073,6037,46292
San Diego-Chula Vista-Carlsbad, CA57$1,054,9926,21374
San Francisco-Oakland-Fremont, CA68$982,7425,69159

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 85 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2021.

Specialties billing 31231 nationally

Otolaryngology accounts for 94% of payment for 31231 nationally in 2021, across 7 specialties on claims.

observed calculated calculated calculated calculated calculated
Otolaryngology4,91987%$75,584,27094%504,660103
Physician Assistant3866.8%$2,313,4832.9%22,11057
Nurse Practitioner2183.8%$1,263,4051.6%10,35347
Ophthalmology500.88%$344,7620.43%2,47850
Allergy/ Immunology350.62%$299,1540.37%1,78251
Plastic and Reconstructive Surgery170.30%$144,8230.18%99559
Internal Medicine140.25%$135,5250.17%74653

Not listed: 10 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 2021.

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