31241 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 31241

1 of 1 payer prior-auth lists that name 31241 require prior authorization or set conditions: Blue Shield of California.

PayerPlanStatePrior authConditionsSinceSource
Blue Shield of CaliforniaBlue Shield commercialCAprior auth under conditionsCalPERS ASO onlySep 1, 2026Prior Authorization List for Blue Shield

Payer coverage policies that name 31241

31241 appears in 9 coverage policies from Aetna, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina.

PayerPolicyRole in policyReviewedDocument
AetnaDevices for Post-Operative Use Following Endoscopic Sinus Surgery (0840)listed, no stance (range 31237-31294)Dec 4, 2025payer document
AetnaMyringotomy and Tympanostomy Tube (0418)listed, no stance (range 31231-31297)Jun 30, 2026payer document
AetnaSeptoplasty and Rhinoplasty (0005)listed, no stance (range 31237-31294)Mar 12, 2026payer document
AetnaSinus Surgeries (0937)not coveredApr 10, 2026payer document
AetnaTezepelumab-ekko (Tezspire) (1003)listed, no stance (range 30000-31299)Aug 6, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 3011F-3210F)Mar 1, 2024payer document
Blue Cross NCSurgical Treatment of Sinus Diseaselisted, no stanceFeb 1, 2026payer document
Blue Shield of CaliforniaFunctional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (7.01.155)listed, no stancepayer document
BlueCross BlueShield of South CarolinaFunctional Endoscopic Sinus Surgery for Chronic Rhinosinusitis (CAM 701155)listed, no stance (range 31231-31294)Nov 1, 2025payer document

Medicaid fee-for-service

  • AZ: $499.77 (asc), effective Oct 1, 2026
  • CO: $359.45 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $304.70 (physician, non-facility), effective Jan 1, 2026
  • IL: $306.43 (practitioner), effective Apr 1, 2024
  • IN: $339.36 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $225.10 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $823.65 (asc), effective Jan 1, 2026
  • LA: $404.38 (professional), effective Jan 1, 2018
  • MA: $327.75 (physician_surgery), effective May 1, 2024
  • MS: $317.52 (comprehensive), effective Jul 1, 2026
  • ND: $393.89 (physician), effective Aug 1, 2026
  • NE: $889.20 (physician, non-facility), effective Jul 1, 2026
  • NY: $247.12 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $358.74 (physician), effective Jan 1, 2018
  • OK: $333.91 (physician, non-facility), effective Jul 1, 2026
  • TX: $298.58 (physician, Physician, facility), effective Sep 1, 2026
  • VA: $323.21 (medical, facility), effective Jul 1, 2026
  • VT: $1382.02 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $216.71 (physician, facility), effective Jul 1, 2026
  • WY: $787.13 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.