Crystal's MCW Coder Hub🧬 CPT Code 31574: Documentation & Billing Guide
Laryngoscopy, Flexible Fiberoptic; with Stroboscopy
Last Updated: February 2026
Status: 2025 Medicare Fee Schedule Compliant
Specialty Tags:
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| Element | Details |
|---|---|
| Code | 31574 |
| Code Type | Diagnostic Procedure - ENT/Otolaryngology |
| Procedure Type | Flexible fiberoptic laryngoscopy with stroboscopic examination |
| Global Period | 000 days (office procedure, no bundled post-op) |
| Work RVU (2025) | 0.56 RVU |
| Practice Expense RVU (2025, Non-Facility) | 0.30 RVU |
| Practice Expense RVU (2025, Facility) | 0.10 RVU |
| Malpractice RVU (2025) | 0.05 RVU |
| Total RVU (2025, Non-Facility) | 0.91 RVU |
| Total RVU (2025, Facility) | 0.71 RVU |
| 2025 Medicare Fee (Non-Facility) | ~32.3465 CF × GPCI) |
| 2025 Medicare Fee (Facility) | ~32.3465 CF × GPCI) |
| Conversion Factor (2025) | $32.3465 |
| Estimated Commercial Insurance | $75 - 250 |
| Global Period Includes | Same-day procedure only; no bundled post-op visits |
| Common Place of Service | Office (11), Hospital outpatient (22), ASC (24) |
| Specialty | Otolaryngology (ENT), Voice Disorders Specialist, Laryngology |
| Procedure Time | 10-20 minutes |
📋SHORT DEFINITION
CPT 31574 describes a flexible fiberoptic laryngoscopy with stroboscopic examination. This diagnostic procedure involves using a flexible endoscope passed through the nose or mouth to visualize the larynx (voice box), combined with stroboscopic light technology to assess vocal cord movement and vibration patterns. Used to evaluate voice disorders, vocal cord lesions, and laryngeal pathology.
LONG DEFINITION
CPT 31574 represents an advanced diagnostic laryngeal examination combining flexible endoscopy with stroboscopic imaging to assess vocal cord physiology and pathology.
Stroboscopy: What It Is and Why It Matters
Stroboscopy Explained:
- Technology: Uses synchronized flashing light at specific frequencies to create the appearance of slow-motion vocal cord movement
- Purpose: Allows visualization of vocal cord vibration characteristics that are invisible to the naked eye at normal motion speeds
- Clinical Value: Detects subtle vocal cord pathology (scar tissue, mucosal waves, asymmetry) not visible with standard laryngoscopy
Key Stroboscopic Parameters Assessed:
- Glottic closure: How completely vocal cords meet during phonation
- Mucosal wave: Traveling wave of mucosa on vocal cord surface during vibration
- Symmetry: Bilateral symmetry of vocal cord movement
- Periodicity: Regularity of vocal cord vibration cycles
- Amplitude: Extent of vocal cord movement
- Hyperkeratosis or scarring: Surface changes to vocal cord tissue
Clinical Indications for 31574
Voice Disorders:
- dysphonia (hoarseness, breathy voice, strained voice)
- Chronic voice fatigue
- Voice loss or complete aphonia
- Vocal tremor or instability
- Suspected vocal cord dysfunction
Vocal Cord Lesions/Pathology:
- Suspected vocal cord nodules, polyps, cysts
- Vocal cord paralysis (unilateral or bilateral)
- Vocal cord atrophy
- Presbylarynx (age-related vocal cord changes)
- Reinke’s edema (swelling of vocal cord tissue)
- Vocal cord scarring or synechiae
- Sulcus vocalis (groove/furrow in vocal cord)
Post-Operative Assessment:
- Follow-up after vocal cord surgery (injection, microsurgery, etc.)
- Assessment of vocal cord healing
- Pre-operative planning for vocal cord procedures
Other Indications:
- Laryngeal papillomatosis monitoring
- Pre-operative voice assessment before cardiac or neck surgery
- Assessment of voice quality in professional voice users
- Evaluation of suspected laryngospasm
- Assessment of stridor etiology
Procedure Technique
Patient Preparation:
- Patient seated comfortably in examination chair
- Topical anesthesia spray applied to nose or throat (lidocaine, benzocaine)
- Vasoconstrictor often applied (oxymetazoline) to reduce nasal congestion
- Patient may gargle with anesthetic solution
- Consent obtained; procedure explained
Flexible Laryngoscopy Technique:
- Flexible fiberoptic endoscope (3.5-4.0 mm diameter) inserted through nose or mouth
- Scope advanced under direct visualization toward larynx
- Larynx positioned in field of view
- Distal end of scope positioned to visualize vocal cords
- Patient may be asked to say specific phonemes (“ah,” “ee”) to assess vocal cord movement
- Scope manipulated to optimize visualization
Stroboscopic Examination:
- Stroboscopic light unit activated (synchronized with endoscopic camera and display)
- Light frequency adjusted based on patient’s fundamental frequency (pitch)
- Video recording obtained of stroboscopic examination at different phonation levels
- Multiple angles assessed (superior view, lateral view, posterior view)
- Patient asked to phonate at different pitches to assess stroboscopic characteristics across frequency range
- Measurements and observations documented
Video Documentation:
- Most modern stroboscopy performed with video recording capability
- Recordings allow for detailed analysis and comparison over time
- Recordings can be reviewed with patient for education
- Recordings become part of medical record
Procedure Duration: Typically 10-20 minutes
Key Distinctions
| Code | Description | Visualization | Stroboscopy | RVU (Work) |
|---|---|---|---|---|
| 31575 | Flexible laryngoscopy with or without stroboscopy | Flexible | Optional | 0.56 |
| 31574 | Flexible laryngoscopy WITH stroboscopy | Flexible | Required | 0.56 |
| 31576 | Flexible laryngoscopy with stroboscopy and voice evaluation | Flexible | Required | 0.67 |
| 31579 | Laryngeal stroboscopy (separate service) | N/A | Required | 0.30 |
| 31512 | Laryngoscopy, indirect; with operating microscope | Indirect mirror/operative microscope | No | 0.30 |
Critical Distinctions:
- 31574 vs. 31575: Both use flexible laryngoscopy. 31574 specifically includes stroboscopy as part of the procedure. 31575 is flexible laryngoscopy without stroboscopy (lower RVU in some versions).
- 31574 vs. 31576: Both include stroboscopy. 31576 adds formal voice evaluation (vocal quality assessment, quantitative voice measures). Use 31576 if comprehensive voice assessment performed; use 31574 if stroboscopy only.
- 31574 vs. 31579: 31574 is flexible laryngoscopy with stroboscopy. 31579 is stroboscopy as a separate add-on service (rarely used; typically included in 31574 or 31576).
Important Note:
Stroboscopy is the key differentiator for CPT 31574. If performing flexible laryngoscopy WITHOUT stroboscopy, use CPT 31575 instead (lower RVU).
WORK RELATIVE VALUE UNITS (wRVUs) & COMPONENTS
Work RVU Breakdown (2025)
| RVU Component | Value | What It Represents |
|---|---|---|
| Work RVU | 0.56 | Physician work, technical skill, interpretation |
| Practice Expense RVU (non-facility) | 0.30 | Endoscopy equipment, stroboscopy equipment, office staff |
| Practice Expense RVU (facility) | 0.10 | Lower due to hospital/ASC equipment overhead |
| Malpractice RVU | 0.05 | Malpractice insurance and liability (diagnostic procedure, low-risk) |
| TOTAL RVU (non-facility) | 0.91 | Total relative value units |
| TOTAL RVU (facility) | 0.71 | Total relative value units (lower) |
RVU Conversion to Dollar Amount (2025)
Formula: RVU × Conversion Factor (CF) × Geographic Practice Cost Index (GPCI) = Payment
2025 Medicare Conversion Factor: $32.3465
Typical Calculations (Non-Facility, GPCI = 1.0):
- 0.56 wRVU × 18.11** (work component)
- 0.30 PE RVU × 9.70** (practice expense)
- 0.05 MP RVU × 1.62** (malpractice)
- Total = ~$29.43 per procedure (non-facility, GPCI 1.0)
Facility-Based (Hospital/ASC):
- 0.56 wRVU × 18.11** (work component, same)
- 0.10 PE RVU × 3.23** (practice expense, lower)
- 0.05 MP RVU × 1.62** (malpractice, same)
- Total = ~$22.99 per procedure (facility, GPCI 1.0)
Real-World Range (2025):
- Non-Facility (office): 35 (depending on GPCI)
- Facility-Based (hospital, ASC): 27
GLOBAL PERIOD
Global Period Status: 000 days (Zero-Day Global)
What This Means:
- CPT 31574 is a diagnostic procedure with NO global period
- There are NO pre-operative or post-operative days bundled
- The code includes only the procedure on the date of service
- No global period modifiers (-54, -55, -56) are needed
- Post-operative follow-up visits are separately billable
Billing Implications:
- Patient follow-up for results discussion or management planning = separate E/M code (99212-99215 established, 99201-99205 new)
- Same-day E/M + 31574 can be billed together with modifier -25 (separate, identifiable E/M)
- Example: 99213-25 (E/M for voice disorder evaluation) + 31574 (stroboscopic laryngoscopy)
DOCUMENTATION REQUIREMENTS FOR 31574
Minimum Documentation Components
Indication/History:
- Chief Complaint: Voice hoarseness, dysphonia, voice loss, suspected vocal cord lesion, etc.
- History of Present Illness: Onset of symptoms, duration, progression, associated symptoms (pain, stridor, aspiration, etc.)
- Symptom Impact: Effect on voice quality, professional/personal impact, functional limitations
- Risk Factors: Smoking, voice abuse, reflux, allergies, chemical exposures
- Prior Treatments: Voice therapy, medications, prior laryngeal procedures
- Imaging or Prior Findings: Any prior laryngoscopy results, CT/MRI findings
Pre-Procedure Assessment:
- Relevant Medical History: Medications (anticoagulants, steroids), comorbidities affecting procedure (cardiovascular, respiratory, swallowing disorders)
- Allergies: Especially to anesthetics, antibiotics
- Current Voice Assessment: Subjective voice quality description, voice fatigue, phonation difficulties
Procedure Description:
- Approach: Transnasal vs. transoral
- Anesthesia: Topical anesthesia used (lidocaine, benzocaine); vasoconstrictor used (oxymetazoline); amount
- Endoscope Type/Size: Flexible laryngoscope specifications (diameter, type)
- Visualization: Ease of visualization, any anatomic variations noted (deviated septum, large uvula, etc.)
- Vocal Cord Assessment - CRITICAL:
- Position at rest: abduct, adduct, or paramedian
- Appearance: Color, swelling, lesions, scarring, surface characteristics
- Movement/Mobility: Bilateral movement symmetry, range of motion, any restriction
- Specific findings: Lesions (nodules, polyps, cysts), paralysis, atrophy, edema, granulation, etc.
- Size/location: If lesion present, specific location on vocal cord (anterior, middle, posterior)
Stroboscopic Examination:
- Light Frequency/Pitch: Fundamental frequency at which stroboscopy performed
- Stroboscopic Parameters Assessed:
- Glottic closure: Incomplete, complete, with bowing
- Mucosal wave: Present, reduced, or absent
- Symmetry: Symmetrical, asymmetrical
- Periodicity: Regular, irregular
- Amplitude: Normal, reduced, or increased
- Hyperkeratosis/scarring: Presence, location, extent
- Video Recording: Performed and documented; saved to patient record
- Multiple Phonation Levels: Assessment at different pitch levels documented (if applicable)
Findings Summary:
- Overall Assessment: Normal, abnormal (specify pathology)
- Specific Diagnoses: Vocal cord nodules, paralysis, paresis, atrophy, etc.
- Comparison to Prior Studies: If prior laryngoscopy available, comparison noted
Recommendations:
- Management Plan: Voice therapy referral, follow-up imaging, surgical intervention consideration, conservative management, etc.
- Follow-up: When to re-examine, indication for follow-up
Complications:
- None vs. specific issues (epistaxis, laryngospasm, aspiration, difficulty with intubation, etc.)
BILLING RULES & MODIFIERS
Global Period Coverage
What’s Included in 31574: ✓ The stroboscopic laryngoscopy procedure ✓ Visualization and assessment of larynx ✓ Stroboscopic analysis ✓ Video recording and documentation
✗ NOT Included (Can bill separately):
- E/M visit (even same day) - requires modifier -25
- Voice evaluation/voice analysis (if formal voice assessment performed, use CPT 31576 instead or bill separate voice evaluation code)
- Laryngeal injection or treatment - separate treatment codes
Common Modifiers
| Modifier | Description | When to Use |
|---|---|---|
| -25 | Significant, separately identifiable E/M | When billing E/M same day; apply to E/M, not 31574 |
| -59 | Distinct procedural service | Rare with laryngoscopy |
| -LT/-RT | Left/Right side | Not typically used with 31574 (bilateral larynx assessment) |
| None (most common) | Standard billing | Routine stroboscopic laryngoscopy |
Modifier -25 Usage (Common):
- When: Patient presents with voice complaint; provider evaluates voice disorder (E/M) AND performs stroboscopic laryngoscopy (31574) same day
- Apply -25 to: The E/M code, not the laryngoscopy code
- Example: 99213-25 (E/M for dysphonia) + 31574 (stroboscopic laryngoscopy)
MEDICARE RULES FOR 31574
CMS-Specific Rules & Policies
1. Global Period Management
- Zero-day global period - no pre-op or post-op visits bundled
- Follow-up visits for results discussion or management = separately billable
2. Facility vs. Non-Facility Billing
- Non-Facility (office): Higher PE RVU (0.30), higher reimbursement (~$29)
- Facility (hospital, ASC): Lower PE RVU (0.10), lower reimbursement (~$23)
- Facility bills separately for facility charges
3. E/M + Laryngoscopy Billing (Common Scenario)
- Can bill 31574 + E/M same day with modifier -25 on E/M
- E/M must be separately identifiable (not routine to laryngoscopy)
- Example: 99213-25 + 31574
4. Stroboscopy as Standard Component
- Stroboscopy is considered standard component of 31574; do NOT bill separately
- CPT 31579 (laryngeal stroboscopy) is an add-on code rarely used; typically included in 31574 or 31576
5. Video Recording Included
- Video recording of stroboscopic examination is included in 31574
- Do NOT bill separately for video recording or archiving
LOCAL COVERAGE DETERMINATIONS (LCDs) & NATIONAL COVERAGE
National Coverage Determination (NCD)
There is NO specific NCD for CPT 31574 (flexible laryngoscopy with stroboscopy).
General Medicare Coverage Policy:
- Laryngoscopy covered when medically necessary to evaluate laryngeal symptoms or pathology
- Must have documented clinical indication
- Coverage determined at MAC level (varies by jurisdiction)
Local Coverage Determinations (LCDs) - MAC-Specific
LCDs vary by Medicare Administrative Contractor (MAC) jurisdiction.
Common LCD Requirements for Laryngoscopy:
| Requirement | Details |
|---|---|
| Medical Necessity | Voice disorder, hoarseness, suspected vocal cord lesion, or functional assessment |
| Documentation | Indication for procedure, symptoms, clinical assessment documented |
| Diagnosis Code | ICD-10 showing voice disorder, hoarseness, or laryngeal pathology |
| Frequency | Typically covered annually or as clinically indicated; frequency limits may apply |
To Find Your MAC’s LCD:
- Go to CMS LCD Search Tool: https://www.cms.gov/cclc/lcd
- Enter your MAC jurisdiction
- Search for “laryngoscopy,” “stroboscopy,” or “voice evaluation”
- Review specific coverage criteria and frequency limits
2025 REIMBURSEMENT INFORMATION
Medicare 2025 Fee Schedule
CPT 31574 - Flexible Laryngoscopy with Stroboscopy
| Category | Value |
|---|---|
| Work RVU | 0.56 |
| Practice Expense RVU (non-facility) | 0.30 |
| Practice Expense RVU (facility) | 0.10 |
| Malpractice RVU | 0.05 |
| Total RVU (non-facility) | 0.91 |
| Total RVU (facility) | 0.71 |
| Conversion Factor (2025) | $32.3465 |
| National Average Fee (Non-Facility, GPCI 1.0) | $29.43 |
| Estimated Range (Non-Facility) | $27 - 35 |
| National Average Fee (Facility, GPCI 1.0) | $22.99 |
| Estimated Range (Facility) | $21 - 27 |
Year-Over-Year Comparison (2024 vs 2025)
| Metric | 2024 | 2025 | Change |
|---|---|---|---|
| Work RVU | 0.56 | 0.56 | — |
| PE RVU (non-facility) | 0.30 | 0.30 | — |
| CF | $33.2875 | $32.3465 | -2.8% |
| National Average (Non-Facility) | ~$30.33 | ~$29.43 | -2.8% |
Commercial Insurance & Medicaid Reimbursement (2025)
Commercial Insurance:
- Typically pays 2-3× Medicare rates
- Estimated 31574 payment: 250 (varies by payer)
- Most insurers cover laryngoscopy with appropriate clinical indication
Medicaid:
- Varies significantly by state
- Estimated 31574 payment: 50 (state-dependent)
- Most states cover laryngoscopy when medically necessary
- Some states require prior authorization
Self-Pay/Cash Price:
- Typically 200
COMPARISON TO RELATED CODES
Laryngoscopy Code Family
| Code | Description | Type | Stroboscopy | RVU (Work) |
|---|---|---|---|---|
| 31575 | Flexible laryngoscopy, with or without stroboscopy | Flexible | Optional | 0.56 |
| 31574 | Flexible laryngoscopy WITH stroboscopy | Flexible | Required | 0.56 |
| 31576 | Flexible laryngoscopy WITH stroboscopy and voice evaluation | Flexible | Required | 0.67 |
| 31579 | Laryngeal stroboscopy (add-on code) | N/A | Required | 0.30 |
| 31512 | Indirect laryngoscopy; with operating microscope | Indirect microscope | No | 0.30 |
| 31505 | Laryngoscopy, indirect; simple | Indirect mirror | No | 0.15 |
Key Comparisons:
- 31574 vs. 31575: Same RVU (0.56) in most fee schedules; 31574 specifically includes stroboscopy
- 31574 vs. 31576: 31574 = stroboscopy only (0.56 RVU); 31576 = stroboscopy + formal voice evaluation (0.67 RVU)
- 31574 vs. 31579: 31574 is standalone; 31579 is add-on code (rarely used separately)
FREQUENTLY BILLED SCENARIOS FOR 31574
Scenario 1: Dysphonia Evaluation with Stroboscopy
Patient: 52-year-old with 3-month history of hoarseness
Clinical Assessment:
- Voice quality: Hoarse, breathy, reduced volume
- Duration: 3 months, gradually worsening
- Risk factors: Former smoker (quit 5 years ago), voice overuse at work
- Prior treatment: None
Procedure:
- Transnasal flexible laryngoscopy performed
- Bilateral vocal cords visualized
- Stroboscopic examination performed at patient’s fundamental frequency
- Findings: Left vocal cord nodule (anterior-middle junction, ~3mm), normal right vocal cord
- Stroboscopic assessment: Incomplete glottic closure, reduced mucosal wave, asymmetrical vibration
- Video recording obtained and archived
Assessment: Dysphonia secondary to left vocal cord nodule
Coding:
- 31574 (flexible laryngoscopy with stroboscopy)
- Diagnosis: R49.0 (dysphonia), J38.1 (polyps of vocal cord and larynx) [or appropriate nodule code]
Scenario 2: Post-Vocal Cord Injection Evaluation
Patient: 38-year-old post-vocal cord injection (hyaluronic acid) for unilateral vocal cord paresis; follow-up evaluation
Clinical Assessment:
- Prior procedure: Vocal cord injection 3 weeks ago
- Voice improvement: Subjectively improved voice quality and projection
- Current symptoms: Minimal hoarseness, near-normal voice
Procedure:
- Transnasal flexible laryngoscopy
- Vocal cord position assessed
- Injected material visibility assessed
- Stroboscopic examination: Improved glottic closure, symmetric vibration improving, mucosal wave returning
- Video recording for comparison with pre-injection studies
Coding:
- 31574 (flexible laryngoscopy with stroboscopy)
- Diagnosis: J38.01 (unilateral vocal cord paresis), Z98.89 (encounter for follow-up post-operative)
Scenario 3: E/M + Stroboscopic Laryngoscopy (Same Day)
Patient: 65-year-old with chronic dysphonia and voice fatigue
Office Visit:
- Chief complaint: Chronic hoarseness and voice fatigue
- History: 2-year progressive worsening, smoking history, vocal strain
- Physical exam: Dry cough, normal general exam
- Assessment: Dysphonia; evaluation indicated
- E/M Level: 99213 (established patient, moderate complexity)
Procedure:
- Transnasal flexible laryngoscopy with stroboscopy
- Findings: Bilateral vocal cord atrophy (presbylarynx), reduced mucosal wave, decreased amplitude
Coding:
- 99213-25 (E/M for dysphonia evaluation, separate identifiable service)
- 31574 (flexible laryngoscopy with stroboscopy)
DOCUMENTATION TIPS FOR 31574
What to Document
✓ SHOULD INCLUDE:
- Indication - Voice complaint, symptom description, functional impact
- Onset and Duration - When symptoms started, how long present
- Risk Factors - Smoking, voice abuse, reflux, occupational exposures
- Approach - Transnasal vs. transoral
- Anesthesia - Topical agent used, vasoconstrictor applied
- Vocal Cord Appearance at Rest:
- Bilateral appearance description
- Color, swelling, lesions
- Position (abducted, adducted, paramedian)
- Vocal Cord Movement:
- Mobility assessment (normal, restricted, paralyzed)
- Symmetry of movement
- Range of motion
- Specific Findings - If pathology present:
- Location (anterior, middle, posterior third)
- Size (mm if measurable)
- Type (nodule, polyp, cyst, scarring, etc.)
- Stroboscopic Parameters - CRITICAL:
- Glottic closure pattern
- Mucosal wave characteristics
- Symmetry of vibration
- Periodicity and regularity
- Amplitude of motion
- Video Recording - Documented as obtained and archived
- Overall Assessment - Normal vs. abnormal; specific diagnosis
- Comparison to Prior Studies - If prior laryngoscopy available
- Recommendations - Voice therapy, follow-up, imaging, surgical consideration, etc.
- Complications - None or specific issues
✗ SHOULD AVOID:
- Vague findings (“vocal cord looks abnormal” without description)
- No documentation of stroboscopic findings
- Missing anatomy description
- No video recording documentation
- Copy-paste documentation without case-specific details
Sample Documentation Template
STROBOSCOPIC LARYNGOSCOPY NOTE (CPT 31574)
PATIENT: [Name]
DATE: [Date]
PROVIDER: [Name, Credentials]
LOCATION: Office / Outpatient clinic
INDICATION: [Age]-year-old patient presents with [voice complaint: hoarseness / dysphonia / voice loss / hoarseness / other] for evaluation.
HISTORY:
- Onset: [Duration] ago
- Symptoms: [Hoarseness, vocal fatigue, reduced volume, breathy voice, straining, other]
- Progression: [Stable / progressive / intermittent]
- Functional impact: [Professional voice user / social impact / work limitations]
- Risk factors: [Smoking history, voice abuse, reflux, allergies, chemical exposure, other]
- Prior treatment: [Voice therapy, medications, prior procedures]
PHYSICAL EXAMINATION:
Voice Quality Assessment: [Subjective assessment of voice quality; hoarse, breathy, strained, weak, other]
Laryngeal Examination:
- Approach: Transnasal flexible laryngoscopy
- Anesthesia: Topical [lidocaine / benzocaine] applied; oxymetazoline vasoconstrictor applied
- Visualization: Easy / moderate difficulty / difficult
Vocal Cord Appearance at Rest:
- Right vocal cord: [Appearance: normal pink color / edema / lesion / etc.]
- Left vocal cord: [Appearance: normal pink color / edema / lesion / etc.]
- Position at rest: [Paramedian / abducted / other]
- Mobility: [Normal / restricted / paralyzed]
Specific Findings (if abnormal): [If lesion or pathology present:]
- Location: [Anterior / middle / posterior third]
- Size: [X mm if measurable]
- Description: [Nodule / polyp / cyst / scar / edema / granulation / other]
- Bilateral assessment: [Symmetrical or asymmetrical]
Stroboscopic Examination:
Stroboscopy Parameters Assessed at [fundamental frequency]:
- Glottic closure: [Complete / incomplete / with bowing]
- Mucosal wave: [Present and normal / reduced / absent]
- Symmetry: [Symmetrical / asymmetrical]
- Periodicity: [Regular / irregular / aperiodic]
- Amplitude: [Normal / reduced / increased]
- Hyperkeratosis/scarring: [None / present on right / present on left / bilateral]
Video Recording: Stroboscopic video recording obtained and archived in patient electronic medical record.
ASSESSMENT:
Findings: [Normal larynx vs. specific findings] [If abnormal: Vocal cord [nodule / paresis / paralysis / atrophy / other] noted.]
Impression: [Diagnosis] Example: “Bilateral vocal cord atrophy (presbylarynx) with reduced mucosal wave amplitude”
Comparison to Prior Studies: [If available: “Compared to prior laryngoscopy [date]; findings [stable / improved / worsened / other]”]
PLAN:
Recommendations:
- Voice therapy referral (if appropriate)
- Reassessment [timeframe]
- [Other management recommendations]
Patient education: [Provided / deferred]
AUDIT DEFENSE CHECKLIST FOR 31574
Before billing 31574, verify:
- Indication documented - Voice complaint or laryngeal symptom clearly stated
- Vocal cord appearance described - Specific description of findings (normal or abnormal)
- Stroboscopic examination documented - Stroboscopic parameters assessed and documented
- Specific findings documented - If pathology present, location, size, and description noted
- Video recording documented - As obtained and archived
- Comparison to prior studies - If prior laryngoscopy available, comparison noted
- Overall assessment documented - Normal vs. abnormal; specific diagnosis
- Management plan documented - Recommendations for follow-up or treatment
- E/M + 31574 properly coded - If E/M performed same day, E/M coded with -25 modifier
- Diagnosis code supports indication - ICD-10 shows voice disorder or laryngeal pathology
- No billing of stroboscopy separately - Stroboscopy included in 31574; do NOT bill CPT 31579 separately
RED FLAGS FOR AUDITORS
31574 claims are at audit risk if:
- ❌ Indication not documented (no voice complaint or laryngeal symptom stated)
- ❌ Stroboscopic findings not documented (stroboscopy claimed but findings not described)
- ❌ Vague vocal cord findings (“vocal cord looks okay” without specifics)
- ❌ No video recording documented or referenced
- ❌ Documentation appears copy-pasted without case-specific details
- ❌ Diagnosis code unrelated to voice disorder or laryngeal pathology
- ❌ E/M + 31574 billed without -25 modifier on E/M
- ❌ Stroboscopy billed separately (31579) when included in 31574
- ❌ No documentation of stroboscopic parameters (glottic closure, mucosal wave, etc.)
FREQUENTLY ASKED QUESTIONS (FAQs)
Q: Can I bill 31574 + E/M same day?
A: Yes. Bill E/M with modifier -25 (separate identifiable service) + 31574. E/M must be separately identifiable from the laryngoscopy (e.g., voice disorder evaluation is separately billable from the procedure itself).
Q: Should I bill 31574 or 31576?
A: Use 31574 for stroboscopic laryngoscopy. Use 31576 if you’re performing formal voice evaluation/voice analysis (quantitative voice measures, voice quality assessment). If just stroboscopy without formal voice testing, use 31574.
Q: Can I bill stroboscopy separately (31579)?
A: Not typically. Stroboscopy is included in 31574 and should NOT be billed separately. CPT 31579 is an add-on code rarely used; most stroboscopy is included in 31574 or 31576.
Q: What if I can’t complete the laryngoscopy due to patient intolerance?
A: Document the attempt and reason for inability to complete. You can still bill 31574 for the attempted procedure, though some payers may deny or reduce payment.
Q: Can I bill for video recording separately?
A: No. Video recording is included in 31574 and cannot be billed separately.
Q: How often can I bill 31574?
A: Medicare typically covers laryngoscopy annually or as clinically indicated. Verify your MAC’s LCD for frequency limits. Commercial payers may have different policies.
REAL-WORLD BILLING TIPS
Tips to Maximize Compliance & Revenue
- Document indication thoroughly - Clear voice complaint or laryngeal symptom
- Describe stroboscopic findings specifically - Don’t just say “normal”; document glottic closure, mucosal wave, symmetry, etc.
- Document vocal cord findings in detail - Location, size (if lesion), appearance
- Use -25 modifier with E/M - When both services performed same day
- Document video recording - Note that stroboscopic video obtained and archived
- Compare to prior studies - If available, note comparison
- Keep notes specific - Avoid copy-paste; describe actual findings
- Use appropriate diagnosis code - ICD-10 should match findings
- Document management plan - Recommendations for follow-up or referral
- Verify frequency limits - Check MAC LCD for frequency restrictions
BILLING & CODING RESOURCES
Recommended Resources:
- AMA CPT Manual 2025 - Official CPT code definitions
- CMS Fee Schedule Database: https://www.cms.gov/medicare/physician-fee-schedule
- MAC LCDs: https://www.cms.gov/cclc/lcd
- American Academy of Otolaryngology (AAO): https://www.entnet.org (coding resources)
- Voice and Voice Disorders Societies - Specialty guidance on voice evaluation coding
- Your payer’s provider manual - Payer-specific frequency limits and requirements
SUMMARY TABLE
| Element | Details |
|---|---|
| Official Definition | Flexible fiberoptic laryngoscopy with stroboscopy |
| Global Period | 000 days (no bundled post-op) |
| Work RVU (2025) | 0.56 |
| Total RVU (2025, Non-Facility) | 0.91 |
| Medicare Payment (2025, Non-Facility) | ~$29 |
| Medicare Payment (2025, Facility) | ~$23 |
| Typical Time | 10-20 minutes |
| Provider Required | Otolaryngologist, laryngologist, ENT specialist, speech-language pathologist (in some states) |
| Common Modifiers | -25 (separate E/M), -59 (distinct procedure) |
| Typical Use | Voice disorder evaluation, vocal cord lesion assessment, post-operative vocal cord monitoring |
| Common Mistakes | Missing stroboscopic findings documentation; not using -25 for E/M; billing stroboscopy separately |
| Audit Risk | Low (straightforward diagnostic procedure, minimal documentation required) |
| Bundling | Stroboscopy included; video recording included; do NOT bill separately |
| Telehealth Allowed | No (requires in-person laryngoscopy) |
Document Created: February 2026
Compliant with: 2025 Medicare Physician Fee Schedule, CMS National and Local Coverage Determinations
Last Updated: February 2026