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    OpenPayerBilling CodesEndoscopy Procedures on the Accessory SinusesCPT cpt-31291-endoscopic-nasal-repair-csf-leak-sphenoid
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    CPT 31291: Endoscopic Repair of CSF Leak in Sphenoid Sinus

    Medicare pays $1092 on average nationally for this procedure.

    CPT code 31291 describes endoscopic repair of a cerebrospinal fluid (CSF) leak in the sphenoid sinus using an endoscope inserted through the nasal cavity; the procedure is an endoscopic skull base repair typically performed as an inpatient or outpatient surgical service in an operating room or specialized endoscopy suite, and involves tissue grafting (for example, muscle graft) to close the dural defect and stop CSF leakage.

    For related coverage guidance, see recent payer policy updates: Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders, Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 48-year-old patient presents with clear unilateral rhinorrhea that increases with Valsalva and positional changes, recurrent meningitis, and imaging (CT and MRI) demonstrating a defect of the lateral wall of the sphenoid sinus with associated cerebrospinal fluid (CSF) leak. The otolaryngology/neurosurgery team schedules an endoscopic transnasal repair. Under general anesthesia in an operating room setting, the surgeon inserts a nasal endoscope (31291) to localize the sphenoid sinus defect, confirms active CSF egress, and harvests a graft (for example, autologous fascia or muscle) or uses a free mucosal/vascularized flap to seal the leak. Intraoperative steps include endoscopic visualization, defect debridement, graft placement with multilayer closure when indicated, and intraoperative Valsalva to test closure integrity. Postoperative workflow includes short observation in a post-anesthesia care unit, possible inpatient monitoring if meningitis risk or neurosurgical involvement exists, head-of-bed elevation, avoidance of nose-blowing, and outpatient follow-up with endoscopic inspection. Typical site of service is the hospital operating room or ambulatory surgery center. Service type is endoscopic skull base repair/CSF leak repair via transnasal endoscopic approach.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    31295Nasal/sinus endoscopy, surgical; with repair of CSF leak of anterior skull baseAlternative or adjacent code used for CSF leak repairs involving the frontal or ethmoid skull base; may be reported if the leak is not confined to the sphenoid.
    61582Transnasal or transsphenoidal excision of pituitary tumor, endoscopic or microscopic, with or without intraoperative imagingPerformed when a concomitant sellar lesion necessitates tumor resection during the same endoscopic approach.
    20936Muscle, myocutaneous, or fasciocutaneous flap; trunkWhen a regional or free flap harvest is required for skull base reconstruction adjunctive to the endoscopic repair.
    31237Nasal/sinus endoscopy, diagnosticUsed preoperatively or intraoperatively for diagnostic endoscopic evaluation of the nasal cavity and sinuses prior to definitive 31291 repair.
    76937Ultrasound guidance for vascular access requiring ultrasound guidance and imaging documentationMay be used intraoperatively for vascular access or monitoring adjuncts during complex cases.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Y00000XOtolaryngology PhysicianAn otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ea…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    207K00000XAllergy & Immunology PhysicianAn allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Select…
    208000000XPediatrics PhysicianA pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
    261QX0100XOccupational Medicine Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    3416L0300XLand AmbulanceTransportation Services · Ambulance
    363LX0001XObstetrics & Gynecology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    207T00000XNeurological Surgery PhysicianA neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and reh…

    Related Payer Policy Updates

    Specialty: Anesthesiology1 / 3

    9 rows

    PolicyPayerEffective Date
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use DisordersPremera Bluecross2026-07-01
    Elective Inpatient Services (for Idaho Only)UnitedHealthcare2026-06-01
    Sites of Servicepriority health2026-06-01
    Coverage for Ambulatory Surgery Unit (ASU)/Outpatient Facility and Anesthesia for Dental Servicesuniverahealthcare2026-05-21
    Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_BlocksCigna2026-05-15
    Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric DisordersBlue Cross Blue Shield - North Carolina2026-04-01

    Related Codes

    CPT-31231-DIAGNOSTIC-NASAL-ENDOSCOPY-NASAL-CAVITY-EVALUATION

    CPT 31231: Nasal Endoscopy, Diagnostic

    CPT-31233-MAXILLARY-SINUS-DIAGNOSTIC-ENDOSCOPY-THROUGH-CANINE-FOSSA-OR-INFERIOR-MEATUS

    CPT 31233: Diagnostic Endoscopy of Maxillary Sinus via Canine Fossa

    CPT-31235-SPHENOID-SINUS-DIAGNOSTIC-ENDOSCOPY

    CPT 31235: Diagnostic Endoscopy of Sphenoid Sinus

    CPT-31237-NASAL-ENDOSCOPY-BIOPSY-POLYPECTOMY-DEBRIDEMENT

    CPT 31237: Nasal/Sinus Endoscopy with Biopsy or Polypectomy

    CPT-31238-ENDOSCOPIC-NASAL-HEMOSTASIS

    CPT 31238: Endoscopic Nasal Cautery for Control of Bleeding

    CPT-31239-DACRYOCYSTORHINOSTOMY-EXTERNAL-DCR

    CPT 31239: Dacryocystorhinostomy (External DCR)

    CPT-31240-ENDOSCOPIC-CONCHA-BULLOSA-REMOVAL

    CPT 31240: Endoscopic-Assisted Concha Bullosa Removal

    CPT-31241-ENDOSCOPIC-SPHENOPALATINE-ARTERY-LIGATION-NASAL

    CPT 31241: Endoscopic Ligation of Sphenopalatine Artery

    CPT-31242-POSTERIOR-NASAL-NERVE-RADIOFREQUENCY-ABLATION-ENDOSCOPIC

    CPT 31242: Endoscopic Posterior Nasal Nerve Radiofrequency Ablation

    CPT-31243-POSTERIOR-NASAL-NERVE-CRYOABLATION-ENDOSCOPIC

    CPT 31243: Endoscopic Posterior Nasal Nerve Cryoablation

    Showing 1–10 of 28

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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