HCPCS 31231

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

Procedures Work RVU per service 1.10 (2022 fee schedule)

5,908
95th percentile among 6,326 codes billed · 2022
$83M
97th percentile among 6,326 codes billed · 2022
604K
94th percentile among 6,326 codes billed · 2022
52
76th percentile among 6,326 codes billed · 2022
331
76th percentile among 6,326 codes billed · 2022
+3.7%
Medicare payment on the code vs 2021; billers +4.2% · 2022

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 York517$14,652,87884,92399528
Florida494$11,458,32380,64287515
California485$9,401,12383,22869422
New Jersey220$5,332,73931,978112411
Texas425$4,580,63933,10248241
Pennsylvania297$4,486,48233,28459376
Illinois224$2,817,40921,15368286
Massachusetts185$2,666,60319,68451338
Maryland125$2,566,15816,18174389
Georgia223$2,142,44916,19454205
Arizona118$1,804,93713,21769331
Virginia161$1,689,24412,29240260
North Carolina190$1,614,54613,02443210
South Carolina118$1,538,01812,36273277
Connecticut83$1,159,3857,32157259

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

Not listed: 3 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 2022.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ541$17,474,72499,968131
Los Angeles-Long Beach-Anaheim, CA183$4,533,35551,31873
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD173$3,724,32126,79093
Miami-Fort Lauderdale-West Palm Beach, FL149$3,640,32224,49988
Chicago-Naperville-Elgin, IL-IN184$2,769,30120,36171
Boston-Cambridge-Newton, MA-NH143$2,302,53916,96859
Houston-Pasadena-The Woodlands, TX128$1,857,54012,83156
Washington-Arlington-Alexandria, DC-VA-MD-WV117$1,687,04610,04145
Baltimore-Columbia-Towson, MD63$1,589,81910,292108
Atlanta-Sandy Springs-Roswell, GA139$1,488,75710,83158
Tampa-St. Petersburg-Clearwater, FL73$1,229,6468,81981
Jacksonville, FL41$1,205,6648,956148
Phoenix-Mesa-Chandler, AZ83$1,202,1368,82465
San Diego-Chula Vista-Carlsbad, CA60$1,101,8366,84786
San Francisco-Oakland-Fremont, CA65$1,070,1636,56571

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 89 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2022.

Specialties billing 31231 nationally

Otolaryngology accounts for 93% of payment for 31231 nationally in 2022, across 7 specialties on claims.

observed calculated calculated calculated calculated calculated
Otolaryngology4,99284%$77,316,13093%550,595110
Physician Assistant4848.2%$3,101,5293.7%30,04262
Nurse Practitioner2674.5%$1,659,2442.0%14,51454
Allergy/ Immunology460.78%$375,6820.45%2,39652
Ophthalmology540.91%$241,4240.29%2,07138
Plastic and Reconstructive Surgery190.32%$175,3740.21%1,25166
Internal Medicine160.27%$141,1030.17%82552

Not listed: 12 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 2022.

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