31575

🧬 CPT Code 31575: Documentation & Billing Guide

Laryngoscopy, Flexible Fiberoptic; Diagnostic

Last Updated: February 2026
Status: 2025 Medicare Fee Schedule Compliant
Specialty Tags:

QUICK REFERENCE

Element	Details
Code	31575
Code Type	Diagnostic Laryngoscopy (Flexible Fiberoptic)
Procedure Type	Endoscopic diagnostic procedure (respiratory tract)
Global Period	000 days (office/outpatient procedure, no bundled post-op)
Work RVU (2025)	0.58 RVU
Practice Expense RVU (2025, Non-Facility)	0.72 RVU
Practice Expense RVU (2025, Facility)	0.29 RVU
Malpractice RVU (2025)	0.05 RVU
Total RVU (2025, Non-Facility)	1.35 RVU
Total RVU (2025, Facility)	0.92 RVU
2025 Medicare Fee (Non-Facility)	~ $43.67 (1.35 R V U \times$ 32.3465 CF × GPCI)
2025 Medicare Fee (Facility)	~ $29.76 (0.92 R V U \times$ 32.3465 CF × GPCI)
Conversion Factor (2025)	$32.3465
Estimated Commercial Insurance	$150 - 250
Common Place of Service	Office (11), Hospital outpatient (22), ASC
Specialty	00 Otolaryngology Specialty (ENT) (ENT), Laryngology, Speech-Language Pathology
Bundling Status	NOT routinely bundled with E/M (separate procedure)

📋SHORT DEFINITION

CPT 31575 describes a diagnostic flexible fiberoptic laryngoscopy, a minimally invasive endoscopic procedure in which a thin, flexible tube with a light and camera is inserted through the nose or mouth to visualize and examine the larynx (voice box) and surrounding structures for abnormalities, pathology, or functional disorders.

LONG DEFINITION

CPT 31575 represents a diagnostic examination of the larynx and upper airway using a flexible fiberoptic or distal-chip laryngoscope. Unlike the older “mirror laryngoscopy” (CPT 31505), the flexible scope provides superior visualization and allows for:

Direct visualization of vocal cords and laryngeal structures
Assessment of vocal cord mobility (unilateral/bilateral paralysis, paresis)
Identification of pathology: nodules, polyps, cysts, granulomas, edema, erythema, masses
Evaluation of airway patency and obstruction
Assessment of swallowing function and aspiration risk
Photo/video documentation for medical record and patient education

Common Clinical Indications:

Chronic hoarseness or voice changes
Vocal cord dysfunction or paralysis
Dysphagia (difficulty swallowing) evaluation
Chronic cough evaluation
stridor or airway obstruction assessment
Laryngeal mass or lesion evaluation
Post-intubation or post-surgical evaluation
Suspected laryngeal paralysis (unilateral or bilateral)
Pre-operative vocal cord assessment
Assessment of vocal cord mobility before thyroid or cardiac surgery

Procedure Details:

Typically performed in office or outpatient surgery setting
Local anesthesia (topical spray) may be used to minimize discomfort
Takes 5-15 minutes typically
Non-invasive (no biopsy, no injection)
Can be diagnostic ONLY (31575) or diagnostic with intervention (31576-31578 if biopsy, injection, removal, or ablation is added)

Key Distinction:

CPT 31575 = DIAGNOSTIC ONLY (visualization, no tissue removal or intervention)
CPT CPT-31574-66761-Guide = Diagnostic with biopsy
CPT 31577 = Diagnostic with operative manipulation (e.g., lesion removal)
CPT 31578 = Diagnostic with botulinum toxin injection

WORK RELATIVE VALUE UNITS (wRVUs) & COMPONENTS

Work RVU Breakdown (2025)

RVU Component	Value	What It Represents
Work RVU	0.58	Physician work and cognitive effort for procedure
Practice Expense RVU (non-facility)	0.72	Equipment, scope, instruments, supplies, staff support
Practice Expense RVU (facility)	0.29	Lower due to hospital/ASC equipment overhead
Malpractice RVU	0.05	Malpractice insurance and liability
TOTAL RVU (non-facility)	1.35	Total relative value units
TOTAL RVU (facility)	0.92	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):

0.58 wRVU × $32.3465 = * *$ 18.76** (work component)
0.72 PE RVU × $32.3465 = * *$ 23.29** (practice expense)
0.05 MP RVU × $32.3465 = * *$ 1.62** (malpractice)
Total = ~$43.67 per procedure (non-facility, GPCI 1.0)

Facility-Based (Hospital/ASC):

0.58 wRVU × $32.3465 = * *$ 18.76** (work component, same)
0.29 PE RVU × $32.3465 = * *$ 9.38** (practice expense, lower)
0.05 MP RVU × $32.3465 = * *$ 1.62** (malpractice, same)
Total = ~$29.76 per procedure (facility, GPCI 1.0)

Real-World Range (2025):

Non-Facility (Office): $40 - 50 (depending on GPCI)
Facility-Based (Hospital/ASC): $26 - 34 (lower PE RVU)

GLOBAL PERIOD

Global Period Status: 000 (Zero-Day Global)

What This Means:

CPT 31575 is an office/outpatient 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 procedure results, complications, or findings = separate E/M code (99212-CPT_99215_Template established, 99201-99205 new)
Same-day E/M + 31575 can be billed together with modifier -25 (separate, identifiable E/M)
If procedure requires facility charges, facility may bill facility fee in addition to professional fee

DOCUMENTATION REQUIREMENTS FOR 31575

Minimum Documentation Components

Indication/History:

Chief Complaint: “Voice change,” “hoarseness,” “dysphagia,” etc.
History of Present Illness: Onset, duration, severity, associated symptoms
Relevant PMH: Intubation history, smoking, reflux, autoimmune conditions
Current Medications: Especially if relevant to laryngeal pathology

Procedure Description:

Approach: Transnasal or transoral
Anesthesia: Topical spray (lidocaine, benzocaine), or note if no anesthesia
Scope type: Flexible fiberoptic or distal-chip laryngoscope
Landmarks visualized: Vocal cords, arytenoids, false cords, epiglottis, piriform sinuses, posterior pharyngeal wall
Bilateral assessment: Specifically note bilateral vocal cord status

Findings:

Left vocal cord: Position (abducted, paramedian, medial), mobility (moves, fixed), appearance (color, edema, lesions, paralysis)
Right vocal cord: Same as above
Other structures: Polyps, nodules, masses, granulomas, cysts, ulcerations, erythema
Airway patency: Degree of obstruction (if any)
Laryngeal sensory function: If tested (gag reflex, cough)

Assessment/Impression:

Primary findings: “Bilateral vocal cord paralysis in paramedian position,” “Right vocal cord polyp,” “Laryngeal edema,” etc.
Diagnostic conclusion: “Consistent with vocal cord paralysis,” “Laryngeal mass, must rule out malignancy,” etc.

Plan:

Management: Conservative (voice rest, reflux management), medical (steroids), or procedural (biopsy, injection, removal)
Follow-up: Return PRN, schedule biopsy, refer to speech therapy, etc.
If findings warrant intervention: Document why intervention is needed and note any referrals

Photo/Video Documentation:

If available, attach images or note “video documentation obtained”
Helps support medical necessity and provide visual record

BILLING RULES & BUNDLING

Bundling Rules (CRITICAL)

Important: Flexible laryngoscopy (31575) is NOT automatically bundled with E/M services.

However, payer-specific rules vary:

When 31575 CAN be billed separately:

When medical necessity for the procedure is independently documented in the E/M (e.g., hoarseness requiring visualization to rule out malignancy)
When billed with an E/M on the same day with modifier -25 (distinct, separately identifiable service)

When 31575 may be bundled or denied:

If billed during post-operative global period of another procedure (check the bundling rules for that procedure)
If billing without appropriate E/M support (payer may deny as not medically necessary)
If billed multiple times same day without clear separate indications

Best Practice:

Document the medical necessity in the E/M note
Use modifier -25 with the E/M code when billed same day as 31575
Example: 99213-25 (separate, identifiable E/M) + 31575 (diagnostic laryngoscopy)

Modifiers Commonly Used with 31575

Modifier	Description	When to Use
-22	Increased Procedural Services	Unusually difficult laryngoscopy (e.g., severe edema, difficult anatomy, patient unable to cooperate)
-26	Professional Component	Radiologist/non-ENT provider reading recorded images (rare for 31575)
-52	Reduced Services	Procedure partially reduced or abandoned (e.g., patient unable to tolerate, scope unable to pass)
-59	Distinct Procedural Service	To prevent bundling when same-session 31575 is unrelated to another procedure
None (most common)	Standard billing	Routine diagnostic laryngoscopy

Modifier -25 Usage (When E/M Same Day):

Bill E/M code with -25 modifier (not on 31575)
Example: 99213-25 + 31575
Indicates E/M is distinct and separately identifiable from the procedure

MEDICARE RULES FOR 31575

CMS-Specific Rules & Policies

1. Medical Necessity & Bundling

31575 covered when medically necessary to visualize and assess laryngeal structures
Not covered as routine/screening procedure
American Academy of Otolaryngology-Head & Neck Surgery policy: Flexible laryngoscopy is NOT a routine part of initial exam; must have specific indication

2. Bundling with Other Procedures

Nasal endoscopy (31231-31235) may be bundled with 31575 if performed at same time (check MAC policy)
Flexible laryngoscopy during bronchoscopy: Typically included in the bronchoscopy code, not billed separately
Upper endoscopy/EGD: Flexible laryngoscopy not typically bundled, but verify payer policy

3. Global Period & Post-Op Care

000-day global period applies
Post-operative follow-up visits (if needed) are separately billable
Complications from procedure are covered under the global period for the procedure date

4. Same-Day E/M Billing

Can bill E/M with modifier -25 on same day as 31575
E/M must be separately identifiable (not routine to procedure)
Example: Patient with hoarseness → E/M evaluation (99213-25) + diagnostic laryngoscopy (31575)

5. Place of Service Payment Adjustment

Office (11): Full non-facility fee (~$43-50)
Hospital outpatient (22): Lower fee (~$28-35); hospital bills separate facility charge
ASC (24): Facility rate applies (~$28-35); ASC bills separate facility charge

6. RHC/FQHC Considerations

RHCs/FQHCs may bill 31575 but payment goes to facility’s all-inclusive rate
Individual provider cannot bill separately if employed by RHC/FQHC

LOCAL COVERAGE DETERMINATIONS (LCDs) & NATIONAL COVERAGE

National Coverage Determination (NCD)

There is NO specific national NCD for CPT 31575.

General Medicare Coverage Policy:

Flexible laryngoscopy covered when performed by qualified provider with documented medical necessity
Must be appropriate based on patient’s presenting symptoms/conditions
No frequency limitations per Medicare statute (must be medically necessary)

Local Coverage Determinations (LCDs) - MAC-Specific

LCDs vary by Medicare Administrative Contractor (MAC) jurisdiction.

Common LCD Requirements for 31575:

Requirement	Details
Medical Necessity	Must have documented indication (hoarseness, dysphagia, vocal cord assessment, etc.)
Documentation	Procedure note must include findings (vocal cord position, mobility, lesions, etc.)
Diagnosis Code	ICD-10 diagnosis must support indication (R49.0 hoarseness, R13 dysphagia, etc.)
Bundling Rules	Some MACs may bundle with certain E/M codes or other procedures; verify
Provider Credentials	Must be licensed provider in scope of practice (MD, DO, NP, PA in appropriate specialty)
Frequency	No Medicare-wide limit, but verify MAC policy for unusual frequency

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” or “ENT procedures”
Review any specific coverage rules/documentation requirements

COMMON MODIFIERS & GLOBAL PERIOD RULES

Modifier -22 (Increased Procedural Services)

Use when: Procedure was more complex than typical due to unusual anatomy, patient factors, or clinical circumstances

Examples:

Severe laryngeal edema making visualization difficult
Extremely narrow larynx (pediatric or anatomical variation)
Uncooperative patient requiring extended time
Severe scar tissue or stenosis

Note

Documentation requirement: Must clearly document why procedure was more complex than routine

Modifier -25 (Distinct Procedural Service - With E/M)

Use when: Billing diagnostic laryngoscopy (31575) on same day as E/M code

Apply -25 to the E/M code (not the procedure code)

Example:

Patient presents with voice change (99213 = E/M)
Provider performs diagnostic laryngoscopy to evaluate (31575)
Billing: 99213-25 + 31575

Modifier -52 (Reduced Services)

Use when: Procedure partially reduced or abandoned

Examples:

Patient unable to tolerate scope insertion due to severe gag reflex
Scope unable to advance due to anatomical obstruction
Patient requested procedure be stopped mid-way

Note

Documentation requirement: Must document why procedure was reduced/incomplete and clinical impact

2025 REIMBURSEMENT INFORMATION

Medicare 2025 Fee Schedule

CPT 31575 - Diagnostic Flexible Laryngoscopy

Category	Value
Work RVU	0.58
Practice Expense RVU (non-facility)	0.72
Practice Expense RVU (facility)	0.29
Malpractice RVU	0.05
Total RVU (non-facility)	1.35
Total RVU (facility)	0.92
Conversion Factor (2025)	$32.3465
National Average Fee (Non-Facility, GPCI 1.0)	$43.67
Estimated Range (Non-Facility)	$40 - 50
National Average Fee (Facility, GPCI 1.0)	$29.76
Estimated Range (Facility)	$26 - 34

Year-Over-Year Comparison (2024 vs 2025)

Metric	2024	2025	Change
Work RVU	0.58	0.58	—
PE RVU (non-facility)	0.72	0.72	—
CF	$33.2875	$32.3465	-2.8%
National Average (Non-Facility)	~$44.95	~$43.67	-2.8%
Status	Active	Active	Unchanged

Note

Reason for fee decrease: 2.8% conversion factor reduction due to expiration of temporary 2024 increase.

Commercial Insurance & Medicaid Reimbursement (2025)

Commercial Insurance:

Typically pays 3-5× Medicare rates
Estimated 31575 payment: $150 -$ 300 (varies widely by payer and contract)
United, BCBS, Aetna, Cigna: Usually $180 -$ 250

Medicaid:

Varies significantly by state
Estimated 31575 payment: $25 -$ 100 (state-dependent)
Many states pay only ~50% of Medicare rate for diagnostic procedures
Some states bundle with E/M; others pay separately

Self-Pay/Cash Price:

Typically $150 -$ 300 depending on provider and location

Flexible Laryngoscopy Code Family (31575-31578)

Code	Description	RVU	Use Case
31575	Diagnostic flexible laryngoscopy (visualization only)	0.58 work	Hoarseness, dysphagia, airway assessment
31576	Diagnostic with biopsy	0.89 work	Lesion biopsy, mass evaluation
31577	Diagnostic with operative manipulation (removal, avulsion)	0.96 work	Vocal cord scar lysis, lesion removal
31578	Diagnostic with injection (botulinum toxin)	0.78 work	Spasticity injection, voice enhancement

31575 vs 31505 (Indirect Laryngoscopy)

Aspect	31575 (Flexible)	31505 (Mirror/Indirect)
Method	Flexible scope, nose or mouth	Hand mirror, visualization from back of throat
Visualization	Superior, direct view of cords	Limited, indirect view
RVU	0.58 work	0.17 work (much lower)
Bundling	Separate procedure	Often bundled with E/M
Procedure Time	5-15 minutes	2-5 minutes
Current Use	Standard for diagnostic laryngoscopy	Rarely used (mostly historical)
Coverage	Separately billable	May be bundled

Clinical Note:

Flexible laryngoscopy (31575) is now the standard diagnostic approach; mirror laryngoscopy is rarely used in modern practice.

FREQUENTLY BILLED SCENARIOS FOR 31575

Scenario 1: Evaluation of Hoarseness with Flexible Laryngoscopy

Patient: 62-year-old with 3 months of hoarseness
E/M Assessment: Hoarseness, rule out vocal cord pathology
Procedure: Transnasal flexible laryngoscopy performed under topical anesthesia
Findings: Right vocal cord polyp, 5mm, with minimal inflammation; left vocal cord normal
Coding:

E/M code: 99213-25 (separate identifiable E/M with hoarseness evaluation)
Procedure code: 31575 (diagnostic flexible laryngoscopy)
Diagnosis: R49.0 (hoarseness), D14.1 (polyp of larynx)

Scenario 2: Dysphagia Evaluation with Flexible Laryngoscopy

Patient: 78-year-old post-stroke with difficulty swallowing
E/M Assessment: Dysphagia, aspiration risk evaluation
Procedure: Flexible laryngoscopy to assess vocal cord mobility and swallowing mechanism
Findings: Mild laryngeal edema; bilateral vocal cords mobile; can observe swallowing without aspiration
Coding:

E/M code: 99214-25 (moderate-complexity E/M, post-stroke dysphagia)
Procedure code: 31575 (diagnostic flexible laryngoscopy)
Diagnosis: R13.10 (dysphagia), I63 (cerebral infarction)

Scenario 3: Unilateral Vocal Cord Paralysis Assessment

Patient: 55-year-old s/p thyroidectomy 6 weeks ago, now with voice change
Chief Complaint: Post-operative hoarseness and voice weakness
Procedure: Flexible laryngoscopy to assess bilateral vocal cord mobility
Findings: Right vocal cord in paramedian position, non-mobile; left vocal cord mobile and normally positioned
Assessment: Right unilateral recurrent laryngeal nerve paralysis, likely post-ENT - Thyroidectomy
Plan: Refer to voice specialist for possible injection or surgery
Coding:

E/M code: 99213-25 (E/M for post-op voice change)
Procedure code: 31575 (diagnostic flexible laryngoscopy)
Diagnosis: J38.01 (vocal cord paralysis, unilateral, right), Z90.11 (post-thyroidectomy)

Scenario 4: Stridor/Airway Obstruction Assessment (Pediatric)

Patient: 4-year-old with history of stridor and respiratory difficulty
Chief Complaint: Evaluation of stridor, rule out laryngomalacia or other airway obstruction
Procedure: Flexible laryngoscopy under topical anesthesia
Findings: Supraglottic laryngomalacia with anterior epiglottic folding causing mild airway obstruction during inspiration
Plan: Conservative management with observation; refer to pediatric ENT if worsening
Coding:

E/M code: 99213-25 (E/M for stridor evaluation)
Procedure code: 31575 (diagnostic flexible laryngoscopy)
Diagnosis: R06.1 (stridor), Q31.5 (laryngomalacia)

Scenario 5: Vocal Cord Dysfunction (VCD) Assessment

Patient: 28-year-old athlete with exercise-induced throat tightness and breathing difficulty
Chief Complaint: Suspected vocal cord dysfunction, dyspnea during exercise
Procedure: Flexible laryngoscopy during rest and with Valsalva maneuver to assess vocal cord movement
Findings: At rest, vocal cords abduct normally; with Valsalva, paradoxical vocal cord adduction during expiration
Assessment: Vocal cord dysfunction, suggestive of exercise-induced VCD
Plan: Refer to speech pathology for voice therapy, breathing retraining
Coding:

E/M code: 99213-25 (E/M for dyspnea evaluation)
Procedure code: 31575 (diagnostic flexible laryngoscopy)
Diagnosis: R06.02 (dyspnea), F45.8 (vocal cord dysfunction/functional disorder)

DOCUMENTATION TIPS FOR 31575

What to Document

✓ SHOULD INCLUDE:

Procedure Indication - Chief complaint and reason for laryngoscopy
Patient Positioning - Sitting or supine
Anesthesia - Topical spray (type: lidocaine, benzocaine), dose; or no anesthesia
Scope Used - Flexible fiberoptic or distal-chip; if video recorded, note
Route - Transnasal vs. transoral
Bilateral Assessment - Status of BOTH vocal cords documented separately
Vocal Cord Findings for EACH side:
- Position (paramedian, medial, abducted)
- Mobility (moves freely, paretic, paralyzed, fixed)
- Color/appearance (pale, erythematous, edematous)
- Lesions (polyp, nodule, cyst, mass, scarring, ulceration)
Other Structures Visualized:
- Epiglottis (normal, edematous)
- Arytenoids (normal, erythematous)
- False cords (normal, edematous)
- Piriform sinuses
- Posterior pharyngeal wall
Airway Patency Assessment - Degree of obstruction, if any
Laryngeal Sensory Function - If tested (gag reflex, cough response)
Overall Assessment - Diagnosis or impression (e.g., “bilateral vocal cord paralysis,” “right vocal cord polyp,” “laryngeal edema”)
Plan - Conservative management, referral, follow-up, or scheduling for intervention
Complications - If any (bleeding, excessive coughing, etc.)
Provider Signature/Authentication - Date, time, credentials

✗ SHOULD AVOID:

Vague findings (e.g., “vocal cords normal” without detail on mobility, color, position)
Missing bilateral assessment (must document BOTH cords)
No indication/reason documented
Copy-paste from previous notes without updating
Generic statements without specificity

Sample Documentation Format

Procedure Note - Flexible Laryngoscopy (31575)

INDICATION:
Patient presents with 3 months of progressive hoarseness. Referred by primary care for laryngoscopic evaluation to rule out vocal cord pathology.

PROCEDURE:
After informed consent, patient placed in sitting position. Topical anesthesia applied to nasal cavity (lidocaine 4%, 2 sprays). Flexible fiberoptic laryngoscope advanced transnasally with direct visualization of larynx. Bilateral vocal cords and surrounding structures assessed. Vocal cords moved through phonation cycles for mobility assessment.

FINDINGS:

Left Vocal Cord: Midline position at rest. Abducts symmetrically with inspiration. Adducts completely during phonation. Normal gray-white color. No lesions, edema, or scarring noted. Mobility: Normal.

Right Vocal Cord: Polyp noted on anterior aspect of vocal cord, approximately 5mm in diameter, with white/tan appearance. Mild surrounding erythema. Vocal cord position normal; mobility slightly restricted due to polyp, but otherwise functional. No other lesions or ulceration.

Other Structures: Epiglottis normal. Arytenoid region without erythema. False cords normal. Piriform sinuses patent. Posterior pharyngeal wall normal. Airway patency: Fully patent.

IMPRESSION:
Right vocal cord polyp with minimal surrounding laryngitis. Left vocal cord normal. Unilateral pathology likely source of hoarseness.

PLAN:

Discussed findings with patient. Recommended voice rest and anti-reflux measures (PPI, H2 blocker).
If hoarseness persists beyond 2-4 weeks of conservative management, return for possible biopsy/removal of polyp (CPT 31576).
Will refer for speech-language pathology evaluation for voice therapy.
Follow-up in 4 weeks to reassess.

Complications: None.

AUDIT DEFENSE CHECKLIST FOR 31575

Before billing 31575, verify:

RED FLAGS FOR AUDITORS

31575 claims are at audit risk if:

❌ Documentation minimal or vague (“vocal cords normal” with no detail on mobility, position, color)
❌ Bilateral vocal cord assessment missing (only one cord documented)
❌ No procedure indication documented
❌ Findings are generic or appear copy-pasted from previous visit
❌ Diagnosis code doesn’t match indication (e.g., billing for hoarseness but diagnostic code shows sinusitis)
❌ Procedure billed without supporting E/M (payer may deny as not medically necessary)
❌ Billed multiple times in short interval without clear different indications
❌ E/M billed same day without -25 modifier (may be bundled/denied)
❌ Modifier -22 used without documentation of increased complexity
❌ Procedure appears routine/screening rather than diagnostically indicated

MEDICARE RULES & RESTRICTIONS

Who Can Bill 31575?

Qualified Providers:

MD/DO: Otolaryngologist, laryngologist, internist, family medicine (with appropriate training)
NP: Nurse Practitioner with ENT training and appropriate certification/license
PA: Physician Assistant in ENT specialty or with appropriate ENT training
Other specialists: Pulmonologists, speech-language pathologists (SLP) in some states, with appropriate credentials

Note: Licensure and scope of practice vary by state. Verify state regulations and credentialing with your medical board and payer.

RHC/FQHC Restrictions

If provider is employed by RHC or FQHC:

31575 is reportable but payment goes to facility’s All-Inclusive Rate (AIR) or Prospective Payment System (PPS)
Individual provider cannot bill separately for 31575
Facility receives bundled payment for all services that day

Telehealth Coverage for 31575

CPT 31575 via Telehealth:

NOT typically reimbursed via telehealth because procedure requires direct visualization of larynx with physical equipment
Some state-specific telemedicine policies may allow video review of previously recorded laryngoscopy, but this would not be separately billable as 31575
If consultation about laryngoscopy findings is provided remotely, bill as E/M (99213, 99214, etc.), not as 31575

Concurrent Billing Issues

Same-Day Billing with E/M:

Can bill 31575 + E/M same day with modifier -25 on the E/M code
E/M must be separately identifiable (not just routine to procedure)
Example: 99213-25 (hoarseness evaluation) + 31575 (laryngoscopy)

Same-Day Billing with Other Procedures:

If nasal endoscopy (31231-31235) billed same day, verify payer bundling rules (may be bundled together)
If biopsy added same day, use 31576 instead of 31575 (not both)

COMPLIANCE & CODING EXAMPLES

Appropriate 31575 Use Cases ✓

Hoarseness evaluation - Voice change of unclear etiology requiring visual assessment
Dysphagia assessment - Swallowing difficulty with evaluation of laryngeal/airway involvement
Vocal cord paralysis assessment - Post-operative or post-intubation assessment of vocal cord mobility
Stridor/airway obstruction evaluation - Pediatric or adult with airway symptoms requiring visualization
Laryngeal mass evaluation - Suspected lesion requiring visualization and possible biopsy
Pre-operative vocal cord assessment - Before cardiac surgery or thyroid surgery to document baseline vocal cord function
Chronic cough evaluation - Rule out laryngeal pathology as cause of chronic cough
Aspiration risk assessment - Post-stroke or post-intubation assessment of aspiration risk

Inappropriate 31575 Use (Risks) ✗

❌ Routine screening without indication - Asymptomatic patient, no clinical reason for scope
❌ Part of routine E/M without separate billing support - If procedure is routine part of visit, may be bundled (not separately billable)
❌ Billed without E/M evaluation - Scope-only without clinical assessment/indication
❌ Repeated multiple times in short interval - Unless each has distinct clinical indication
❌ Billed with wrong code - Using 31576 (with biopsy) when only diagnostic visualization performed
❌ Without documented findings - Generic or missing documentation of what was visualized

FREQUENTLY ASKED QUESTIONS (FAQs)

Q: Can I bill 31575 if I perform it in the office without a separate E/M visit?
A: Generally, no. Most payers require an E/M service (with -25 modifier) on the same day to support medical necessity. A “scope-only” visit typically requires documentation of medical necessity through E/M or prior established condition.

Q: Is 31575 covered by Medicare even if it’s the same day as a preventive exam?
A: Yes, if there’s a separate, identifiable indication for the laryngoscopy (not routine to the preventive visit). Bill preventive code + 31575-25 (laryngoscopy as add-on for a specific problem found during preventive exam).

Q: Can I bill 31575 if I only look at the vocal cords but don’t see any pathology?
A: Yes. 31575 is diagnostic; whether or not pathology is found, the visual examination is a billed procedure. The “finding” may be “vocal cords normal” - still billable if medically indicated.

Q: What’s the difference between 31575 and 31576?
A: 31575 is diagnostic ONLY (visualization). 31576 includes a biopsy. If you perform a biopsy, you must use 31576, not 31575.

Q: Do I need a modifier if I perform laryngoscopy with a nasal endoscopy?
A: Possibly. Some payers bundle nasal endoscopy (31231-31235) with flexible laryngoscopy (31575) when performed in the same session. Verify your payer’s bundling rules; you may need modifier -59 to indicate they are distinct.

Q: Can I bill 31575 if I just review a video that was recorded by another provider?
A: No. 31575 requires that YOU perform the procedure. If you’re reviewing a recording and providing a consultation, that’s an E/M code (99213-99215), not 31575.

Q: Is there a frequency limit on 31575?
A: No Medicare-wide frequency limit, but visits must be medically necessary. Payers may question multiple laryngoscopies in a short period without clear distinct indications.

Q: Can I bill 31575 if the patient is on a ventilator in ICU?
A: Yes, if you perform a flexible laryngoscopy (transnasal or via the endotracheal tube). Bill with place of service hospital (22) and note facility location in coding.

REAL-WORLD BILLING TIPS

Tips to Maximize Compliance & Revenue

Document bilateral assessment always - Never skip documenting both vocal cords
Be specific on findings - “Paralysis,” “polyp,” “edema” with location and size
Link to indication - Findings should match why laryngoscopy was indicated
Use -25 with E/M - When billed same day as E/M, modifier -25 on E/M code (not on 31575)
Verify payer bundling rules - Some payers bundle with E/M; check before billing
Document medical necessity in E/M - If billed with E/M same day, E/M note must support why scope was needed
Take photos/video when possible - Provides documentation and educational material
Train staff on billing - Staff should know 31575 is separate from E/M and requires separate coding
Use proper modifiers - -22 if increased complexity, -52 if reduced, -25 with E/M same day
Keep consistent documentation - Use standard format for laryngoscopy findings to ensure completeness

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 (search for “laryngoscopy”)
American Academy of Otolaryngology-Head & Neck Surgery: https://www.entnet.org (coding resources)
Your payer’s provider manual - Payer-specific bundling rules and coverage requirements

SUMMARY TABLE

Element	Details
Official Definition	Laryngoscopy, flexible fiberoptic; diagnostic
Global Period	000 (no bundled post-op)
Work RVU (2025)	0.58
Total RVU (2025, Non-Facility)	1.35
Medicare Payment (2025, Non-Facility)	~$43.67
Medicare Payment (2025, Facility)	~$29.76
Typical Time	5-15 minutes
Provider Required	Yes (MD, DO, ENT, NP, PA in appropriate specialty)
Common Modifiers	-25 (with E/M same day), -22 (increased complexity), -52 (reduced)
Typical Use	Hoarseness, dysphagia, vocal cord paralysis, airway obstruction assessment
Common Mistakes	Missing bilateral documentation; bundling with E/M without -25 modifier; vague findings
Audit Risk	Moderate (proper documentation essential)
Bundling	NOT routinely bundled with E/M (but varies by payer); use -25 if E/M billed same day
Telehealth Allowed	No (requires physical equipment and direct visualization)

Document Created: February 2026
Compliant with: 2021 AMA E/M Guidelines, 2025 Medicare Physician Fee Schedule, CMS NCCI Coding Policy Manual, Current Payer Policies
Last Updated: February 2026

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31575

🧬 CPT Code 31575: Documentation & Billing Guide

Laryngoscopy, Flexible Fiberoptic; Diagnostic

Last Updated: February 2026 Status: 2025 Medicare Fee Schedule Compliant Specialty Tags:

QUICK REFERENCE

📋SHORT DEFINITION

LONG DEFINITION

WORK RELATIVE VALUE UNITS (wRVUs) & COMPONENTS

Work RVU Breakdown (2025)

RVU Conversion to Dollar Amount (2025)

GLOBAL PERIOD

DOCUMENTATION REQUIREMENTS FOR 31575

Minimum Documentation Components

BILLING RULES & BUNDLING

Bundling Rules (CRITICAL)

Modifiers Commonly Used with 31575

MEDICARE RULES FOR 31575

CMS-Specific Rules & Policies

LOCAL COVERAGE DETERMINATIONS (LCDs) & NATIONAL COVERAGE

National Coverage Determination (NCD)

Local Coverage Determinations (LCDs) - MAC-Specific

COMMON MODIFIERS & GLOBAL PERIOD RULES

Modifier -22 (Increased Procedural Services)

Modifier -25 (Distinct Procedural Service - With E/M)

Modifier -52 (Reduced Services)

2025 REIMBURSEMENT INFORMATION

Medicare 2025 Fee Schedule

Year-Over-Year Comparison (2024 vs 2025)

Commercial Insurance & Medicaid Reimbursement (2025)

COMPARISON TO RELATED CODES

Flexible Laryngoscopy Code Family (31575-31578)

31575 vs 31505 (Indirect Laryngoscopy)

FREQUENTLY BILLED SCENARIOS FOR 31575

Scenario 1: Evaluation of Hoarseness with Flexible Laryngoscopy

Scenario 2: Dysphagia Evaluation with Flexible Laryngoscopy

Scenario 3: Unilateral Vocal Cord Paralysis Assessment

Scenario 4: Stridor/Airway Obstruction Assessment (Pediatric)

Scenario 5: Vocal Cord Dysfunction (VCD) Assessment

DOCUMENTATION TIPS FOR 31575

What to Document

Sample Documentation Format

AUDIT DEFENSE CHECKLIST FOR 31575

RED FLAGS FOR AUDITORS

MEDICARE RULES & RESTRICTIONS

Who Can Bill 31575?

RHC/FQHC Restrictions

Telehealth Coverage for 31575

Concurrent Billing Issues

COMPLIANCE & CODING EXAMPLES

Appropriate 31575 Use Cases ✓

Inappropriate 31575 Use (Risks) ✗

FREQUENTLY ASKED QUESTIONS (FAQs)

REAL-WORLD BILLING TIPS

Tips to Maximize Compliance & Revenue

BILLING & CODING RESOURCES

SUMMARY TABLE

Graph View

Table of Contents

Recent Notes

Last Updated: February 2026
Status: 2025 Medicare Fee Schedule Compliant
Specialty Tags: