CPT 31395 Pharyngolaryngectomy Reimbursement | OpenPayer

Summary & Overview

CPT 31395: Pharyngolaryngectomy with Reconstruction

CPT code 31395 defines pharyngolaryngectomy with reconstruction, a major head-and-neck surgical procedure that removes the pharynx and larynx and restores continuity through reconstructive techniques. This code captures high-complexity operative care often required for advanced tumors, severe dysphagia, or airway-threatening conditions. Nationally, the code is relevant for hospital surgical case mix, resource planning, and specialty reimbursement benchmarks due to its operative intensity and postoperative needs.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context, expected service setting, and the kinds of performance and billing considerations associated with this procedure. The publication outlines common modifiers and coding relationships where available, summarizes payer coverage patterns and authorization considerations when reported, and presents benchmark perspectives on utilization and expected resource use.

This summary is intended to inform hospital administrators, coding professionals, and specialty clinicians about the code’s clinical scope, typical care setting, and the payer landscape that influences authorization and reimbursement processes. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare31395CPThead-and-neck-surgerypharyngolaryngectomyreconstructive-surgeryinpatient-surgeryoncology-surgery

Billing Code Overview

CPT code 31395 describes a pharyngolaryngectomy with reconstruction, a surgical procedure in which the provider removes the pharynx and larynx and performs reconstruction. This procedure is commonly performed for patients with severe disease of the upper aerodigestive tract who have significant difficulty swallowing or airway compromise.

Service type: Surgical — Head and Neck Oncology / Reconstructive Surgery

Typical site of service: Inpatient hospital or tertiary care surgical center, often requiring operating room resources, anesthesia, and postoperative inpatient care including possible intensive care or specialized swallowing rehabilitation.

Clinical & Coding Specifications

Clinical Context

A 64-year-old male with progressive dysphagia, recurrent aspiration, and a T3 squamous cell carcinoma involving the larynx and hypopharynx is evaluated by an otolaryngology–head and neck surgical team. After multidisciplinary tumor board review, the decision is made to perform a pharyngolaryngectomy with reconstructive surgery to remove the diseased larynx and involved segments of the pharynx, restore alimentary continuity, and optimize airway and swallowing. The clinical workflow includes preoperative staging (imaging, endoscopy, anesthesia assessment), informed consent emphasizing oncologic resection and reconstruction, operative resection of the larynx and affected pharyngeal tissue, immediate reconstruction (regional flap or free tissue transfer) to recreate the pharyngeal conduit, placement of a tracheostomy and feeding access (PEG or gastrostomy) as indicated, postoperative ICU or step-down monitoring for airway and flap viability, swallow and speech rehabilitation planning, and coordination of adjuvant therapy with medical and radiation oncology as required. Typical site of service is an inpatient acute care hospital or tertiary academic medical center. Service type: major surgical, oncologic head and neck resection with reconstruction.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for this procedure (extensive reconstruction, unusually complex dissection).

CPT 31300: Laryngeal Tumor or Laryngocele Excision with Cordectomy

CPT-31420-EPIGLOTTIDECTOMY-EPIGLOTTIS-EXCISION

CPT 31420: Epiglottidectomy (Excision of Epiglottis)

CPT-31400-EXTERNAL-ARYTENOIDECTOMY-ARYTENOIDOPEXY

CPT 31400: External Arytenoidectomy or Arytenoidopexy

CPT-31390-PHARYNGOLARYNGECTOMY-REMOVAL-PHARYNX-AND-LARYNX

CPT 31390: Pharyngolaryngectomy (Removal of Pharynx and Larynx)

CPT-31380-ANTEROVERTICAL-HEMILARYNGECTOMY-PARTIAL-LARYNGECTOMY

CPT 31380: Anterovertical Hemilaryngectomy (Partial Laryngectomy)

CPT-31360-LARYNGECTOMY-WITHOUT-RADICAL-NECK-DISSECTION

CPT 31360: Laryngectomy Without Radical Neck Dissection

CPT-31370-PARTIAL-LARYNGECTOMY-HORIZONTAL-APPROACH

CPT 31370: Partial Laryngectomy, Horizontal Approach

CPT-31375-LATEROVERTICAL-HEMILARYNGECTOMY-PARTIAL-LARYNGECTOMY

CPT 31375: Laterovertical Hemilaryngectomy, Partial Laryngectomy

CPT-31365-LARYNGECTOMY-WITH-RADICAL-NECK-DISSECTION

CPT 31365: Laryngectomy with Radical Neck Dissection

CPT-31367-SUBTOTAL-LARYNGECTOMY-SUPRAGLOTTIC-EXCISION

CPT 31367: Subtotal (Supraglottic) Laryngectomy

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Taxonomy Code	Specialty	Notes
207C00000X	Otolaryngology (ENT)	Primary specialty performing pharyngolaryngectomy and oncologic resection.
208000000X	General Surgery — Head & Neck Surgery / Surgical Oncology	Often involved in complex head and neck oncologic resections.
208800000X	Plastic and Reconstructive Surgery	Commonly performs reconstruction (regional flap or free tissue transfer) following resection.
363L00000X	Critical Care Medicine	Provides postoperative ICU management for complex airway and flap monitoring.
2084P0800X	Laryngology	Subspecialty within otolaryngology focusing on laryngeal reconstruction and function.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C32.9`	Malignant neoplasm of larynx, unspecified	Primary laryngeal cancers requiring total laryngectomy or extended resection involving the pharynx.
`C13.9`	Malignant neoplasm of hypopharynx, unspecified	Hypopharyngeal tumors that necessitate pharyngolaryngectomy when advanced or involving both larynx and pharynx.
`C10.0`	Malignant neoplasm of vallecula	Tumors in the vallecula that can extend to laryngeal and pharyngeal structures requiring extensive resection.
`C09.0`	Malignant neoplasm of tonsillar pillar	Advanced or recurrent oropharyngeal tumors that may require combined pharyngolaryngeal resection in select cases.
`T81.4XXA`	Infection following a procedure, initial encounter	Postoperative infectious complications that can require reoperation or additional care after pharyngolaryngectomy.
`R13.10`	Dysphagia, unspecified	Common presenting symptom prompting evaluation and surgical intervention when due to structural tumor.
`Z98.890`	Other specified postprocedural states	Relevant for documenting prior surgeries, reconstruction status, or altered anatomy in the perioperative period.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31643`	Laryngectomy, partial or hemilaryngectomy; with repair of trachea or pharynx	May be performed for more limited laryngeal resections or as a component procedure in staged resections prior to or instead of total pharyngolaryngectomy.
`43280`	Esophagoscopy, flexible, transoral; diagnostic, with or without collection of specimen(s) by brushing or washing	Preoperative endoscopic evaluation of the hypopharynx and cervical esophagus to define tumor extent; diagnostic adjunct.
`20969`	Reconstruction, open, with free flap; head and neck area	Common reconstructive technique used immediately after pharyngolaryngectomy to restore pharyngeal continuity and swallowing.
`43246`	Esophagoscopy, flexible, transoral; with removal of foreign body or tumor	Used when removal of obstructing tumor fragments or staged debridement is necessary prior to definitive resection.
`43298`	Esophagoscopy, flexible, transoral; dilation, single or multiple, over guidewire	Performed in the postoperative period for management of pharyngeal or esophageal strictures that can complicate reconstruction.
`43202`	Esophagoscopy, flexible, transoral; with biopsy	Preoperative or intraoperative biopsy of suspicious lesions in the hypopharynx or cervical esophagus to confirm diagnosis.

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