CPT 31546 Endoscopic Laryngoscopy Reimbursement | OpenPayer

Summary & Overview

CPT 31546: Endoscopic Laryngoscopy with Vocal Cord Lesion Excision and Graft

CPT code 31546 represents an endoscopic laryngoscopy procedure in which a clinician uses a flexible endoscope with microscope or telescope assistance to excise one or more benign vocal cord lesions (for example, polyps) and reconstruct the resulting mucosal defect with a separately harvested mucosal graft. This code captures a combined operative effort: diagnostic visualization, lesion removal, and reconstruction, and is used for procedures that go beyond simple excision due to the grafting step.

Nationally, CPT code 31546 is relevant to otolaryngology, head and neck surgery, and procedures performed in ambulatory surgery centers and hospital operating rooms. Key payers commonly involved in coverage and payment determinations for this code include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise clinical and coding context for use of this procedure code, an overview of typical sites of service and service type, and guidance on what to expect in payer coverage and claims processing at a high level. The publication also points to benchmarks and policy considerations affecting billing and authorization for complex endoscopic laryngeal procedures, and summarizes clinical indications and coding boundaries to help stakeholders understand where this code fits in surgical laryngology practice. Data not available in the input for payer-specific rates, related codes, or ICD-10 pairings is omitted.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare31546CPTlaryngoscopyvocal-cord-surgerymucosal-graftotolaryngologyambulatory-surgeryoperating-room

Billing Code Overview

CPT code 31546 describes a surgical laryngoscopy performed with a flexible endoscope and visualization assistance (operating microscope or telescope) to remove one or more benign lesions from a vocal cord and to reconstruct the resulting mucosal defect using a separately obtained mucosal graft.

Service type: Laryngeal surgery with lesion excision and mucosal graft reconstruction
Typical site of service: Operating room or ambulatory surgical center under appropriate anesthesia for endoscopic laryngeal procedures

Clinical & Coding Specifications

Clinical Context

A 45-year-old female singer presents with progressive hoarseness and intermittent vocal fatigue for six months. Flexible transnasal laryngoscopy in clinic identifies a pedunculated benign-appearing polyp on the right true vocal fold with mucosal redundancy and a small adjacent mucosal defect anticipated after excision. The patient is scheduled for an operative microlaryngoscopy using a flexible endoscope and operating microscope/telescope under general anesthesia. The surgeon performs 31546: flexible laryngoscopy with microscope/telescope assistance, excision of one or more benign vocal fold lesions (for example, polyps), and reconstruction of the resulting mucosal defect using a separately harvested mucosal graft. Typical intraoperative workflow includes general endotracheal anesthesia or monitored anesthesia care as indicated, suspension or flexible endoscopic access to the larynx, microscopic visualization, precise micro-instrument excision of the lesion(s), harvesting of a mucosal graft (for example, from the ipsilateral aryepiglottic fold or buccal mucosa as appropriate), graft placement and fixation over the defect, hemostasis, and postoperative laryngeal voice rest and directed speech therapy. Typical site of service is an ambulatory surgery center or hospital operating room. Service type: operative microlaryngoscopy with lesion excision and mucosal graft reconstruction of the vocal fold.

Coding Specifications

Modifier	Description	When to Use
`22`

CPT 31536: Direct Laryngoscopy with Biopsy of the Larynx

CPT-31510-DIAGNOSTIC-LARYNGOSCOPY-WITH-BIOPSY

CPT 31510: Diagnostic Laryngoscopy with Biopsy

CPT-31570-LARYNGOSCOPY-WITH-VOCAL-CORD-INJECTION

CPT 31570: Direct Laryngoscopy with Vocal Cord Injection

CPT-31553-PEDIATRIC-LARYNGOPLASTY-LARYNGEAL-RECONSTRUCTION

CPT 31553: Pediatric Laryngoplasty for Laryngeal Stenosis

CPT-31535-LARYNGOSCOPY-WITH-BIOPSY-LARYNX

CPT 31535: Direct Laryngoscopy with Biopsy of Larynx

CPT-31554-LARYNGOPLASTY-CARTILAGE-GRAFT-INDWELLING-STENT

CPT 31554: Laryngoplasty with Cartilage Graft and Indwelling Stent

CPT-31512-LARYNGOSCOPY-WITH-LESION-EXCISION

CPT 31512: Laryngoscopy with Removal of Laryngeal Lesion

CPT-31527-DIRECT-LARYNGOSCOPY-OBTURATOR-INSERTION

CPT 31527: Direct Laryngoscopy with Obturator Insertion

CPT-31579-LARYNGOSCOPIC-EXAMINATION-WITH-STROBOSCOPY

CPT 31579: Laryngoscopic Examination with Stroboscopy

CPT-31525-DIRECT-LARYNGOSCOPY-LARYNX-TRACHEOSCOPY-OPTIONAL

CPT 31525: Direct Laryngoscopy with Optional Tracheoscopy

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Taxonomy Code	Specialty	Notes
207P00000X	Otolaryngology	Primary specialty performing microlaryngoscopy and vocal fold surgery.
208100000X	Head and Neck Surgery	Surgeons who perform laryngeal microsurgery and reconstruction.
367500000X	Speech-Language Pathology	Involved in pre- and postoperative voice therapy; not typically the billing surgeon but part of care team.
363L00000X	Otology/Neurotology (related)	Occasionally involved for complex laryngeal or airway reconstruction coordination.
207K00000X	Plastic and Reconstructive Surgery	Engaged when mucosal grafting requires specialized reconstructive techniques.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J38.1`	Vocal cord nodules	Common benign lesions causing hoarseness that may be excised during microlaryngoscopy.
`J38.2`	Polyp of vocal cord and larynx	Direct indication for excision of benign vocal fold polyps with possible mucosal grafting.
`J38.3`	Paralysis of vocal cords and larynx, unspecified	May require evaluation during operative planning; not a direct indication for lesion excision but relevant to airway/voice management.
`J38.4`	Other diseases of vocal cords	Captures non-specific benign vocal cord pathology treated with microlaryngoscopy.
`R49.0`	Dysphonia	Symptom frequently prompting evaluation and operative intervention for vocal fold lesions.
`K11.6`	Cysts of oral region, not elsewhere classified	If buccal mucosal graft is harvested, concurrent oral pathology may be relevant.
`Z98.890`	Other specified postprocedural states	Used in postoperative documentation when applicable.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31575`	Laryngoscopy, flexible; with therapeutic intervention such as foreign body removal or dilation (separate procedure)	May be performed in clinic or OR for therapeutic laryngeal procedures; less commonly used when microscopic grafting is required.
`31505`	Laryngoscopy, direct, with tracheoscopy, with or without endotracheal tube changes; diagnostic	Often performed as a diagnostic direct laryngoscopy prior to operative planning or when rigid visualization is needed.
`31237`	Nasal/sinus endoscopy, surgical; with tissue removal	May be billed when harvesting intranasal or intranasal mucosal graft sources are used concurrently.
`41599`	Unlisted procedure, nose (if buccal mucosal graft or other unlisted graft harvest is performed)	Used when graft harvest technique does not have a specific code and must be reported as unlisted alongside `31546`.
`31231`	Nasal endoscopy, diagnostic, with biopsy	May be used if concurrent nasal evaluation with biopsy is performed for graft site assessment or diagnosis.

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