CPT 31225 Intraoral Maxillary Osteotomy: Reimbursement | OpenPayer

Summary & Overview

CPT 31225: Intraoral Maxillary Osteotomy with Removal of Diseased Bone

CPT code 31225 denotes an intraoral surgical procedure to expose and fracture the maxilla for removal of diseased bone. Nationally, this code captures complex surgical management of maxillary pathology, including osteomyelitis, tumor resection, or extensive odontogenic disease that requires direct intraoral access and bone removal. Accurate coding is important for clinical documentation, hospital and ambulatory surgical center billing, and tracking utilization of specialized maxillofacial procedures.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical indications and the typical sites of service where 31225 is performed, along with benchmarking context and common payer considerations. The publication presents benchmarks for utilization and reimbursement practices, summarizes relevant policy updates that affect coverage and prior authorization, and outlines clinical context that supports appropriate use of the code. Data not available in the input is noted where applicable.

This summary is intended for coding professionals, surgical providers, revenue cycle staff, and policy analysts seeking a clear, national-level briefing on CPT code 31225 and its role in operative management of maxillary disease.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare31225CPTmaxillaoral surgerymaxillofacialoperative proceduresurgical debridementambulatory surgery

Billing Code Overview

CPT code 31225 describes an intraoral surgical procedure in which the provider makes an incision inside the mouth to expose the maxilla and then performs intraoperative fracturing of the maxillary bone to remove all or part of diseased bone. This procedure is a form of operative management of maxillary bone pathology and is typically performed by oral and maxillofacial surgeons or otolaryngologists.

Service type: Intraoral maxillary osteotomy with removal of diseased bone (surgical debridement/resection of maxilla)
Typical site of service: Ambulatory surgical center or hospital operating room

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult presenting with chronic maxillary osteomyelitis secondary to odontogenic infection or a neoplastic lesion of the maxilla causing sequestration and refractory pain, swelling, and purulent drainage. The patient has failed conservative therapy (antibiotics, dental extraction, or local debridement) and imaging (CT or panoramic radiograph) demonstrates diseased maxillary bone that requires surgical removal.

Preoperative workflow includes history and physical, review of imaging confirming localized maxillary bony disease, informed consent discussing intraoral approach and partial or complete maxillectomy, preoperative laboratory testing as indicated, and coordination with anesthesia for general endotracheal anesthesia. Intraoperatively an intraoral mucosal incision is made to expose the maxilla; diseased bone margins are delineated and the maxilla is osteotomized/fractured intraoperatively to remove all or part of the affected maxillary bone. Hemostasis, irrigation, possible obturator planning, and intraoral closure complete the procedure. Postoperative care includes pain control, antibiotics as indicated, wound care instructions, oral intake modifications, and planned follow-up for healing and prosthetic rehabilitation if needed.

Typical site of service: Ambulatory surgical center or hospital operating room.

Service type: Surgical – intraoral maxillary resection (partial or total) performed by oral and maxillofacial surgery, otolaryngology, or head and neck surgical teams.

Coding Specifications

Modifier	Description	When to Use

CPT 31205: External Ethmoid Sinusotomy, Removal of Diseased Contents

CPT-31200-ANTERIOR-ETHMOID-SINUS-DEBRIDEMENT-INTRANASAL

CPT 31200: Anterior Ethmoid Sinus Debridement, Intranasal

CPT-31201-ENDOSCOPIC-INTRANASAL-ETHMOID-SINUS-PROCEDURE-WITH-DRAIN-PLACEMENT

CPT 31201: Endoscopic Intranasal Ethmoidectomy with Drain Placement

CPT-31230-MAXILLECTOMY-WITH-ORBITAL-EXENTERATION

CPT 31230: Maxillectomy with Orbital Exenteration, Combined Resection

Taxonomy Code	Specialty	Notes
206E00000X	Oral and Maxillofacial Surgery	Primary specialty performing intraoral maxillectomy and related maxillary resections.
207N00000X	Otolaryngology (ENT)	Head and neck surgeons frequently perform maxillary resections for tumors or extensive infection.
2084P0800X	Plastic and Reconstructive Surgery	Involvement for reconstructive planning and obturator/facial reconstruction when defects are significant.
2080S0120X	General Surgery (Head & Neck)	Surgeons with head and neck focus involved in oncologic resections of the maxilla.
282N00000X	Dental Surgery (Dentist)	Dentists or oral surgeons in ambulatory settings performing intraoral access and limited resections.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M86.60`	Osteomyelitis, unspecified site	Maxillary osteomyelitis may necessitate resection of diseased bone as described by `31225`.
`K10.2`	Inflammatory conditions of jaw	Severe odontogenic or jaw infections leading to bony involvement can require intraoral maxillary resection.
`C41.1`	Malignant neoplasm of maxillary bones and sinuses	Primary malignancy of the maxilla may require partial or total maxillectomy via intraoral approach.
`J33.8`	Other nasal polyp	When extensive sinonasal disease erodes maxillary bone, resection may be part of combined procedures.
`M27.2`	Alveolitis of jaws	Advanced alveolar disease with extension to maxilla can lead to surgical resection when conservative care fails.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21045`	Excision of benign tumor or cyst of maxilla; via intraoral approach	May be performed for localized benign lesions of the maxilla prior to or instead of more extensive resection when disease is limited.
`21246`	Reconstruction of mandible or maxilla, with bone graft; segmental osteotomy, includes obtaining graft	Performed when reconstruction or grafting is required after maxillary resection to restore form and function.
`41899`	Unlisted procedure, dentoalveolar structures	Used for procedures of the maxilla not described by existing CPT codes when billing unique reconstructive or adjunctive services.
`31575`	Laryngoscopy, direct, diagnostic, with or without tracheoscopy; with biopsy	May be performed in the same operative session by ENT surgeons to evaluate contiguous upper aerodigestive tract pathology.
`70553`	MRI brain and orbits with contrast	Preoperative imaging code commonly used to delineate extent of neoplasm involving maxilla (radiology performed preop).

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