ENT Billing Services
ENT billing spans office procedures, audiology testing, sinus and nasal surgery, laryngoscopy, and sleep-related procedures. The breadth requires coders who understand both diagnostic and surgical ENT coding.
Why ENT Billing Requires Specialty Expertise
ENT practices combine high-volume office procedures (cerumen removal, nasal endoscopy, laryngoscopy) with complex sinus and ear surgery. Audiology testing has its own code family, and sleep-related procedures cross multiple specialties.
Common ENT CPT Codes
Our coders handle these ent codes daily. This is not an exhaustive list.
2026 Medicare Allowables for ENT CPT Codes by State
Medicare reimbursement for entprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same ent CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 10 core entcodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | ENT Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 31231 | Diagnostic nasal endoscopy | $220.14 | $190.85 | $198.96 | $214.61 | $190.96 | $193.25 | $180.18 | $187.49 | $181.26 | $186.28 |
| 31237 | Nasal endoscopy with debridement | $294.96 | $263.50 | $278.80 | $294.58 | $264.68 | $272.38 | $251.91 | $261.31 | $250.73 | $261.25 |
| 31628 | Bronchoscopy with biopsy | $459.26 | $403.98 | $419.86 | $450.52 | $404.51 | $409.43 | $384.06 | $397.87 | $385.63 | $395.79 |
| 30520 | Septoplasty | $670.37 | $606.65 | $646.35 | $676.80 | $610.41 | $632.91 | $582.94 | $604.05 | $577.52 | $605.55 |
| 42820 | Tonsillectomy and adenoidectomy, age under 12 | $275.80 | $258.60 | $279.86 | $286.46 | $261.32 | $275.79 | $251.98 | $260.16 | $246.79 | $262.56 |
| 92557 | Comprehensive audiometry, threshold and speech | $39.12 | $35.59 | $36.11 | $38.59 | $35.62 | $35.59 | $34.40 | $35.12 | $34.59 | $34.94 |
| 92551 | Pure tone audiometry screening | $15.60 | $13.13 | $13.72 | $14.99 | $13.12 | $13.23 | $12.23 | $12.83 | $12.37 | $12.70 |
| 69210 | Removal of impacted cerumen, one or both ears | $52.11 | $47.31 | $50.06 | $52.51 | $47.58 | $49.09 | $45.54 | $47.06 | $45.20 | $47.15 |
| 99213 | Established patient office visit, low MDM | $104.31 | $94.46 | $98.20 | $103.97 | $94.79 | $96.44 | $90.97 | $93.60 | $90.84 | $93.44 |
| 99214 | Established patient office visit, moderate MDM | $148.01 | $134.59 | $140.26 | $148.05 | $135.13 | $137.84 | $129.83 | $133.55 | $129.44 | $133.44 |
Full ENT fee detail by state
2026 Medicare allowables for ent CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 31231 | Diagnostic nasal endoscopy | $220.14 | $56.12 |
| 31237 | Nasal endoscopy with debridement | $294.96 | $143.19 |
| 31628 | Bronchoscopy with biopsy | $459.26 | $163.63 |
| 30520 | Septoplasty | $670.37 | $670.37 |
| 42820 | Tonsillectomy and adenoidectomy, age under 12 | $275.80 | $275.80 |
| 92557 | Comprehensive audiometry, threshold and speech | $39.12 | $27.26 |
| 92551 | Pure tone audiometry screening | $15.60 | $15.60 |
| 69210 | Removal of impacted cerumen, one or both ears | $52.11 | $27.61 |
| 99213 | Established patient office visit, low MDM | $104.31 | $59.65 |
| 99214 | Established patient office visit, moderate MDM | $148.01 | $87.54 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
ENT Billing Challenges We Solve
Common billing problems in ent and how our team handles them.
Sinus Surgery Coding
Multiple sinus approaches with add-on codes per sinus. Incorrect selection affects reimbursement significantly.
In-Office Procedures
High-volume cerumen, endoscopy, and laryngoscopy must be captured for every qualifying visit.
Audiology Bundling
Audiometric testing codes have specific bundling rules with E/M visits.
Allergy Testing
ENT allergy testing and immunotherapy have their own coding and documentation requirements.
Common ENT Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most ENT Practices Miss
Payer-Specific ENT Billing Tips
ENT Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
Get Expert ENT Billing Support
Free billing assessment for your ent practice. See where revenue is leaking.
What We Handle for ENT Practices
Why Choose Go Medical Billing for ENT
ENT practices leave revenue on the table when in-office procedures aren't captured. Our team ensures every endoscopy, cerumen removal, and allergy test is coded and billed.
We serve ent practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
ENT Billing by State
We handle ent billing in all 50 states. The 2026 Medicare allowables for ent CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
Get Expert ENT Billing Support
Stop losing revenue to ent coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.