Summary & Overview
CPT 31295: Endoscopic Maxillary Sinus Ostial Dilation
CPT code 31295 denotes endoscopic dilation of the maxillary sinus ostium, a minimally invasive sinonasal procedure used to restore drainage and ventilation of the maxillary sinus. This procedure is clinically important for management of chronic rhinosinusitis and recurrent maxillary sinus obstruction, and it has implications for access, utilization, and coding consistency across national payers. Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find concise benchmarks and clinical context for CPT code 31295, including typical sites of service, common billing considerations, and where this code fits within the spectrum of endoscopic sinus interventions. The publication outlines payer coverage patterns and coding considerations relevant to outpatient and ambulatory surgery settings, highlights policy updates that affect coding and claims adjudication, and summarizes practical issues that impact utilization and documentation. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 31295 describes endoscopic dilation of the maxillary sinus ostium. The procedure involves passing an endoscope into the nasal cavity and dilating the opening (ostium) of the maxillary sinus, either via a purely transnasal approach or through the canine fossa (a depression on the outer surface of the maxilla).
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Service type: Endoscopic sinus procedure (maxillary sinus ostial dilation)
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Typical site of service: Ambulatory surgery center or hospital outpatient department; may also be performed in specialized office settings equipped for endoscopic sinus procedures.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient presents to an otolaryngology clinic with several months of recurrent right-sided facial pressure, purulent nasal drainage, and episodic maxillary tooth pain refractory to multiple courses of oral antibiotics and intranasal corticosteroids. Nasal endoscopy demonstrates a narrowed maxillary sinus ostium with retained purulence. CT sinus demonstrates ostial obstruction and mucosal thickening of the right maxillary sinus. The patient is scheduled for endoscopic maxillary antrostomy with dilation of the maxillary ostium (31295). The clinical workflow includes preoperative evaluation with history, medication reconciliation, informed consent, allergy review, and pre-op imaging review. In the operating room under general anesthesia or monitored anesthesia care, the surgeon introduces a nasal endoscope transnasally (or accesses via the canine fossa if indicated), identifies the natural ostium of the maxillary sinus, and performs dilation of the ostium to restore drainage. Hemostasis is achieved, and postoperative instructions include nasal saline irrigations, short course antibiotics if indicated, and scheduled ENT follow-up with possible debridement in clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing for the surgeon's professional service separate from facility charges (hospital bills technical component). |