CPT 31040 Pterygomaxillary Fossa Reimbursement | OpenPayer

Summary & Overview

CPT 31040: Surgery of the Pterygomaxillary Fossa

CPT code 31040 describes a surgical operation targeting the pterygomaxillary fossa, a deep facial space between the upper jaw and the eye orbit. Nationally, this code matters because procedures in this anatomically complex region carry elevated clinical risk, often require specialized surgical expertise and facility resources, and can affect utilization and payment patterns across payers. Payers commonly relevant to this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare.

Readers will find a concise overview of clinical context for procedures billed with CPT code 31040, including typical settings (operating room or surgical suite) and the nature of the service (surgical access to a deep facial space). The publication summarizes coverage and payment considerations across major commercial payers and Medicare, highlights common documentation and coding themes, and outlines benchmarks and policy updates where available. The content is aimed at clinicians, coding and billing professionals, and policy analysts who need a clear national summary of how this specialized surgical code is used and reimbursed. Data not provided in the input (for example, specific fee schedules, associated ICD-10 diagnoses, or taxonomies) is noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare31040CPTfacial-surgerypterygomaxillary-fossaoperating-roomsurgical-procedurehead-and-neck-surgery

Billing Code Overview

CPT code 31040 describes a surgical procedure that accesses the pterygomaxillary fossa, a trench-like anatomical space located between the upper jaw (maxilla) and the orbit of the eye. The procedure may use any surgical approach to expose and operate within this deep facial space for therapeutic or diagnostic purposes.

Service Type: Surgical procedure involving the pterygomaxillary fossa

Typical Site of Service: Operating room or surgical suite

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult referred to an otolaryngologist or maxillofacial surgeon for surgical access to the pterygomaxillary fossa to manage pathologies such as hemorrhaging internal maxillary artery branches, removal of benign or malignant tumors, treatment of deep-seated odontogenic infections, or control of traumatic bleeding after midfacial fractures. The patient often presents with facial pain, swelling, epistaxis, expanding hematoma, or radiographic evidence of a mass or abscess centered near the posterior maxilla. Preoperative workflow includes history and physical, focused head and neck examination, imaging (CT or CT angiography of the facial skeleton and skull base), anesthesia evaluation, and informed consent outlining risks to adjacent structures (infraorbital nerve, maxillary artery branches, orbit). Intraoperative steps involve general endotracheal anesthesia, surgical approach (transoral, transantral, transfacial or endoscopic approaches as indicated), careful dissection to the pterygomaxillary fossa, identification and control of bleeding or lesion resection, and layered closure. Postoperative workflow includes monitoring for hemorrhage, facial nerve and ocular function assessment, pain control, instruction on wound care, and outpatient follow-up with imaging or endoscopic surveillance as indicated.

Coding Specifications

Modifier	Description	When to Use
`50`	Bilateral procedure	Used if identical procedures are performed on both sides of the pterygomaxillary region during the same operative session.

CPT 31075: Frontal Sinus Excision via Transorbital Approach

CPT-31032-MAXILLARY-ANTROSTOMY-POLYPECTOMY

CPT 31032: Maxillary Antrostomy with Polypectomy

CPT-31084-FRONTAL-SINUS-OBLITERATION-OPEN-FRONTAL-SINUS-SURGERY

CPT 31084: Frontal Sinus Obliteration, Open Frontal Sinus Surgery

CPT-31090-SURGICAL-DRAINAGE-MULTISINUS-SINUSITIS

CPT 31090: Surgical Drainage of Three or More Paranasal Sinuses

CPT-31081-FRONTAL-SINUS-OBLITERATION-CORONAL-INCISION

CPT 31081: Frontal Sinus Obliteration via Coronal Incision

CPT-31087-FRONTAL-SINUS-OSTEOPLASTIC-FLAP-EXCISION

CPT 31087: Frontal Sinus Osteoplastic Flap and Excision

CPT-31050-SPHENOID-SINUS-INCISION-BIOPSY

CPT 31050: Incision of Sphenoid Sinus with Possible Biopsy

CPT-31085-FRONTAL-SINUS-OBLITERATION-OSTEOPLASTIC-FLAP

CPT 31085: Frontal Sinus Obliteration with Osteoplastic Flap

CPT-31080-FRONTAL-SINUS-OBLITERATION-EXTERNAL-APPROACH

CPT 31080: Frontal Sinus Obliteration via External Eyebrow Incision

CPT-31020-MIDDLE-MEATAL-SINUSOTOMY-INTRANASAL-SINUSOTOMY

CPT 31020: Middle Meatal Sinusotomy, Intranasal Approach

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Taxonomy Code	Specialty	Notes
207P00000X	Otolaryngology (ENT)	Common specialty performing access to the pterygomaxillary fossa for skull base and sinonasal pathology.
207X00000X	Oral and Maxillofacial Surgery	Performs transoral/transfacial approaches for maxillary and pterygoid region surgery.
2088P0800X	Plastic and Reconstructive Surgery	Participates for complex reconstructions involving midface and orbital support.
207K00000X	Neurological Surgery	Involved when skull base or intracranial extension requires neurosurgical expertise.
2080P0222X	General Surgery (Head & Neck)	Occasionally involved for oncologic resections involving adjacent structures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C41.2`	Malignant neoplasm of bones of skull and face	Malignancies of the maxilla or adjacent bones may require access to the pterygomaxillary fossa for resection.
`J34.89`	Other specified disorders of nose and nasal sinuses	Deep sinonasal tumors or inflammatory masses extending posteriorly may necessitate this approach.
`K10.2`	Cellulitis and abscess of oral soft tissues, including periapical abscess with sinus	Deep odontogenic infections or abscesses tracking to the pterygomaxillary space can require surgical drainage.
`S02.4`	Fracture of the malar and maxillary bones	Midface fractures with posterior extension may require surgical exposure of the fossa to control hemorrhage and repair.
`R04.0`	Epistaxis	Severe posterior epistaxis originating from branches in the pterygomaxillary region may require surgical ligation or exposure.
`D18.02`	Hemangioma of other intracranial and intraspinal sites	Vascular lesions encroaching on the pterygomaxillary fossa may need surgical control.
`M26.69`	Other specified disorders of jaw, not elsewhere classified	Miscellaneous jaw pathologies extending to posterior maxilla that require operative access.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31255`	Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)	May be performed before or in conjunction to improve visualization or gain endoscopic access to posterior maxillary regions.
`21240`	Excision or curettage of lesion of mandible or maxilla; full-thickness, complicated	Used when bony resection of the maxilla is required for tumor access adjacent to the pterygomaxillary fossa.
`33140`	Resection of mediastinal tumor, transthoracic approach	Data not available in the input.
`21470`	Open treatment of maxillary fracture, with internal fixation	Performed in the trauma setting when midface stabilization is required in conjunction with access to the fossa.
`61582`	Craniectomy or craniotomy; partial temporal, with microscopic excision of intradural cranial neoplasm	Data not available in the input.
`69990`	Microsurgical techniques, requiring use of operating microscope	May be reported when microsurgical magnification is essential for delicate vascular or nerve dissection.

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