CPT 31590 Laryngeal Reinnervation Reimbursement | OpenPayer

Summary & Overview

CPT 31590: Laryngeal Neuromuscular Flap Reinnervation

CPT code 31590 designates a complex reconstructive surgical procedure that resupplies nerves to the larynx using a neuromuscular flap to treat laryngeal and facial paralysis. Nationally, this code captures high-complexity, function-restoring interventions performed by otolaryngology and head and neck surgical teams; accurate coding is important for clinical tracking, quality measurement, and appropriate payment for specialized operative care. Major payers typically involved in coverage for this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

This publication provides a concise overview of clinical context and coding implications for CPT code 31590. Readers will find: a clinical summary of the procedure and its role in managing laryngeal and facial nerve dysfunction; payer coverage landscape and common reimbursement considerations; and practical benchmarking and policy context where available. Data not available in the input will be noted. The content is intended for clinicians, coding professionals, and policy analysts seeking a clear national-level summary of the code and its relevance to surgical practice and payer interactions.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare31590CPTlaryngeal-reinnervationneuromuscular-flaphead-and-neck-surgeryotolaryngologyreconstructive-surgery

Billing Code Overview

CPT code 31590 describes a surgical procedure in which a provider resupplies nerves to the larynx using a neuromuscular flap to treat laryngeal and facial paralysis. The procedure involves transferring or augmenting neural and muscular components to restore laryngeal function and address associated facial nerve deficits.

Service type: Surgical, reconstructive neuromuscular procedure
Typical site of service: Hospital operating room or specialized surgical center for otolaryngology/head and neck surgery

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient presents with unilateral vocal fold paralysis and ipsilateral facial weakness following resection of a skull base schwannoma. Symptoms include dysphonia, aspiration with thin liquids, and significant facial asymmetry causing eye closure difficulty. After multidisciplinary evaluation by otolaryngology and plastic/reconstructive surgery, the plan is reinnervation of the larynx using a neuromuscular flap to restore vocal fold tone and improve airway protection. The typical clinical workflow: preoperative laryngoscopic examination, stroboscopy, and swallow evaluation; preoperative counseling and medical clearance; operative transfer to an OR equipped for microvascular and nerve surgery; general anesthesia with intraoperative nerve monitoring; harvest and inset of a neuromuscular flap with microvascular anastomosis and nerve coaptation to reinnervate the laryngeal musculature; immediate postoperative airway monitoring in PACU and overnight observation; postoperative speech-language pathology rehabilitation and serial laryngoscopic assessments over months to monitor reinnervation and functional improvement.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when reporting only the surgeon's professional component and facility bills technical component separately.
`50`

CPT 31592: Tracheal Resection with Primary Anastomosis for Subglottic Stenosis

CPT-31591-VOCAL-CORD-MEDIALIZATION-LARYNGEAL-RESTORATION

CPT 31591: Medialization of Displaced or Paralyzed Vocal Cord

CPT-31584-LARYNGOPLASTY-REPAIR-LARYNGEAL-FRACTURE

CPT 31584: Laryngoplasty for Laryngeal Fracture

CPT-31580-LARYNGOPLASTY-LARYNGEAL-WEB-REMOVAL-KEEL-PLACEMENT

CPT 31580: Laryngoplasty for Laryngeal Web Removal with Keel Placement

CPT-31587-CRICOID-SPLIT-LARYNGOPLASTY-SUBGLOTTIC-AIRWAY-ENLARGEMENT

CPT 31587: Laryngoplasty (Cricoid Split) for Subglottic Airway Enlargement

Taxonomy Code	Specialty	Notes
207K00000X	Otolaryngology	Primary specialty performing laryngeal reinnervation and airway surgery.
2080P0001X	Plastic Surgery	Often performs microvascular flap harvest and inset for neuromuscular transfer.
208U00000X	Neurological Surgery	In complex skull base or nerve injury cases, may collaborate for nerve identification and coaptation.
2084P0800X	Head and Neck Surgery	Subspecialty involved in reconstruction and oncologic nerve repairs.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G51.0`	Bell's palsy	Facial nerve paralysis that may coexist with or complicate facial reanimation planning when laryngeal reinnervation is considered.
`G51.1`	Geniculate ganglionitis	Facial nerve disorders that can be associated with peripheral facial paralysis necessitating neuromuscular flap procedures.
`G52.1`	Injury of vagus nerve	Direct or iatrogenic vagus nerve injury can cause vocal fold paralysis addressed by laryngeal reinnervation.
`G52.2`	Injury of recurrent laryngeal nerve	Common cause of unilateral vocal fold paralysis; direct target for reinnervation procedures.
`J38.00`	Vocal cord paralysis, unspecified	General diagnosis indicating impaired vocal fold mobility that can be treated with nerve resupply or augmentation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31575`	Laryngoplasty, medialization (thyroplasty), with or without implant	May be performed before or after reinnervation to improve vocal fold position and glottic closure.
`31576`	Laryngoplasty, lateralization, with or without implant	Alternative glottic procedure for airway compromise that can complement reinnervation strategies.
`15730`	Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis (free flap)	Describes harvest and microvascular transfer of a neuromuscular flap used to reinnervate laryngeal muscles.
`69990`	Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)	Utilized intraoperatively for nerve coaptation and microvascular anastomosis during neuromuscular flap transfer.
`92507`	Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual	Postoperative voice therapy sessions provided by speech-language pathology to support functional recovery after reinnervation.

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