HCPCS 31231

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

Procedures Work RVU per service 1.10 (2023 fee schedule)

6,206
96th percentile among 6,405 codes billed · 2023
$90M
97th percentile among 6,405 codes billed · 2023
669K
94th percentile among 6,405 codes billed · 2023
53
75th percentile among 6,405 codes billed · 2023
354
76th percentile among 6,405 codes billed · 2023
+7.6%
Medicare payment on the code vs 2022; billers +5.0% · 2023

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 York516$15,674,36893,773107578
Florida523$12,801,50291,49492544
California539$10,844,391103,36666425
New Jersey230$5,867,34836,162118457
Pennsylvania317$4,768,10136,32961384
Texas448$4,591,07733,89948231
Illinois241$3,016,83122,58059285
Massachusetts191$2,977,40122,14360343
Maryland128$2,643,14517,07570383
Georgia229$2,131,57616,46651184
Arizona122$1,991,39214,82270331
South Carolina138$1,699,58813,68363299
North Carolina201$1,677,73313,63341207
Virginia170$1,659,65112,54643235
Colorado123$1,176,1118,61544197

Not listed: 2 billers with an armed-forces or unknown state code (AE, 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 2023.

Top metro areas

observed calculated calculated calculated calculated
New York-Newark-Jersey City, NY-NJ549$18,948,504111,820139
Los Angeles-Long Beach-Anaheim, CA200$5,457,87367,09571
Miami-Fort Lauderdale-West Palm Beach, FL156$4,223,65928,83198
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD183$3,937,95629,079103
Chicago-Naperville-Elgin, IL-IN200$2,983,72121,81470
Boston-Cambridge-Newton, MA-NH150$2,632,02219,48867
Houston-Pasadena-The Woodlands, TX134$1,876,66813,41364
Washington-Arlington-Alexandria, DC-VA-MD-WV123$1,736,02010,74341
Baltimore-Columbia-Towson, MD64$1,624,16710,652109
Atlanta-Sandy Springs-Roswell, GA142$1,518,50011,32853
Tampa-St. Petersburg-Clearwater, FL72$1,480,26510,683114
Phoenix-Mesa-Chandler, AZ83$1,340,31310,00369
Jacksonville, FL45$1,267,7539,595128
San Diego-Chula Vista-Carlsbad, CA68$1,239,9008,36988
San Francisco-Oakland-Fremont, CA73$1,169,4477,11365

Source: CMS Medicare Physician & Other Practitioners public use files (Original Medicare Part B fee-for-service). The 88 areas with the most payment among those with at least 11 billers; non-metro parts of each state are one area. Data year 2023.

Specialties billing 31231 nationally

Otolaryngology accounts for 92% of payment for 31231 nationally in 2023, across 7 specialties on claims.

observed calculated calculated calculated calculated calculated
Otolaryngology5,09082%$82,490,94792%604,643119
Physician Assistant62010.0%$3,820,5834.3%35,96158
Nurse Practitioner3395.5%$2,062,8922.3%18,88456
Allergy/ Immunology460.74%$432,4900.48%2,83062
Ophthalmology510.82%$232,8900.26%1,98939
Plastic and Reconstructive Surgery220.35%$184,0990.21%1,33361
Internal Medicine150.24%$117,0930.13%71948

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 2023.

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