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CPT 31591: Medialization of Displaced or Paralyzed Vocal Cord

CPT code 31591 denotes surgical medialization of a displaced or paralyzed vocal cord to restore laryngeal function for improved breathing, vocalization, and swallowing. Nationally, this code represents a specialized otolaryngology procedure used to treat unilateral vocal fold paralysis or displacement that compromises airway protection and voice. Use of the code is relevant to surgical case mix, perioperative resource planning, and post‑acute voice and swallowing rehabilitation needs.

Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical context for the procedure, typical sites of service, and the service type. The publication also summarizes payer coverage patterns and coding considerations, benchmark utilization, and relevant policy updates that affect authorization and post‑operative care pathways.

This resource helps clinicians, coding professionals, and policy analysts understand the administrative and clinical dimensions of CPT code 31591, including where the procedure is commonly performed and why accurate coding matters for surgical quality measurement, reimbursement workflow, and patient access.

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Billing Code Overview

CPT code 31591 describes a surgical procedure to restore laryngeal function by medializing a displaced or paralyzed vocal cord to improve breathing, voice, and swallowing. This procedure repositions a vocal fold that is displaced to one side back toward the midline to optimize glottic closure and airway protection.

Service type: Surgical laryngeal reconstruction/medialization of the vocal cord
Typical site of service: Hospital operating room or ambulatory surgery center where otolaryngology (head and neck) surgical procedures are performed

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CPT 31591: Medialization of Displaced or Paralyzed Vocal Cord

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Billing Code Overview

Service type: Surgical laryngeal reconstruction/medialization of the vocal cord
Typical site of service: Hospital operating room or ambulatory surgery center where otolaryngology (head and neck) surgical procedures are performed

Clinical & Coding Specifications

Clinical Context

A 62-year-old male presents with progressive hoarseness, weak cough, and occasional aspiration after a left-sided posterior inferior cerebellar artery (PICA) stroke three months earlier. Laryngoscopic examination demonstrates left vocal fold paralysis in the paramedian position with incomplete glottic closure and reduced airway protection. The multidisciplinary workflow begins with an otolaryngology evaluation including flexible laryngoscopy and voice assessment. Following conservative measures (voice therapy, swallow evaluation) and discussion of risks/benefits, the surgeon schedules an operative medialization thyroplasty to restore the paralyzed vocal cord toward the midline to improve phonation and swallowing. On the day of service the patient is admitted to an ambulatory surgery center or hospital operating room (typical sites of service) for regional or general anesthesia. Intraoperative steps include laryngeal exposure, localization of the paraglottic space, creation of a thyroplasty window in the thyroid cartilage, insertion and adjustment of an implant or injection material to medialize the vocal fold, intraoperative voice testing (when possible), hemostasis, and closure. Postoperative workflow includes voice and swallow precautions, outpatient otolaryngology follow-up for stroboscopy or laryngoscopy, and speech pathology for voice rehabilitation. Typical payors for coverage review and prior authorization include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, ongoing postoperative care	Use when reporting a subsequent visit related to global period care if applicable for professional component billing contexts.
`22`	Increased procedural services	Use when work required is substantially greater than typically required for this procedure.
`50`	Bilateral procedure	Use if bilateral medialization procedures are performed during the same operative session.
`51`	Multiple procedures	Use when additional unrelated procedures are performed in the same session (as permitted by payer rules).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Procedure discontinued	Use when the procedure is terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons from different surgical specialties work together as primary surgeons.
`66`	Surgical team	Use when a surgical team performs distinct component tasks during the procedure.
`78`	Return to operating room for a related procedure during global period	Use when a related complication requires return to OR within the global period.
`79`	Unrelated procedure or service by the same physician during global period	Use when an unrelated procedure is performed during the global period.
`LT`	Left side	Use to identify laterality when procedure is side-specific.
`RT`	Right side	Use to identify laterality when procedure is side-specific.
`22`	Increased procedural services	(listed above) — included once; use per payer guidance.

Taxonomy Code	Specialty	Notes
`207Y00000X`	Otolaryngology (ENT)	Primary specialty performing thyroplasty and laryngeal medialization.
`207L00000X`	Facial Plastic Surgery	May perform laryngeal procedures in practices focused on head and neck surgery.
`2084P0800X`	Plastic and Reconstructive Surgery	Occasionally involved when structural reconstructive expertise is required.
`207RP0000X`	Otolaryngology - Pediatric	Pediatric laryngology for congenital or pediatric neurogenic vocal fold immobility.
`363LF0000X`	Speech-Language Pathology	Provides pre- and post-procedure voice and swallow therapy (allied health taxonomy).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J38.01`	Paralysis of vocal cords and larynx, unilateral	Common indication for medialization thyroplasty to improve glottic closure and voice.
`J38.02`	Paralysis of vocal cords and larynx, bilateral	May require medialization or alternate airway/voice strategies; bilateral cases are complex.
`R49.0`	Dysphonia	Symptom code commonly associated with vocal fold immobility prompting evaluation for medialization.
`R13.10`	Dysphagia, unspecified	Swallowing dysfunction related to incomplete glottic closure, improved by medialization.
`I69.398`	Other sequelae of cerebral infarction	Neurologic cause of vocal fold paralysis where medialization addresses symptom sequelae.
`G51.0`	Bell palsy	Cranial nerve dysfunction sometimes associated with laryngeal involvement or concurrent neuropathies.
`C80.1`	Malignant neoplasm without specification of site, metastatic	Neoplastic invasion can cause vocal fold fixation or paralysis prompting surgical intervention.
`J38.6`	Other diseases of vocal cords	Miscellaneous laryngeal disorders that may necessitate surgical medialization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31575`	Laryngoscopy, flexible; diagnostic	Performed preoperatively for diagnosis and visualization of vocal fold position.
`31579`	Laryngoscopy with stroboscopy	Used in voice assessment pre- and postoperatively to evaluate vibratory function.
`31625`	Laryngoplasty, open (including thyroplasty)	Related open laryngeal reconstructive techniques; sometimes used interchangeably in operative planning.
`31582`	Laryngoscopy, direct with biopsy	Performed if suspicious lesion requires tissue diagnosis prior to or during airway procedures.
`92507`	Treatment of speech and language, individual	Speech-language pathology services for postoperative voice rehabilitation and therapy.
`31595`	Laryngoplasty; other (injectable medialization)	Endoscopic or injectable augmentation techniques commonly performed instead of or in addition to open medialization.

CPT 31580: Laryngoplasty for Laryngeal Web Removal with Keel Placement

CPT-31584-LARYNGOPLASTY-REPAIR-LARYNGEAL-FRACTURE

CPT 31584: Laryngoplasty for Laryngeal Fracture

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

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

CPT-31590-LARYNGEAL-NEUROMUSCULAR-FLAP-REINNERVATION

CPT 31590: Laryngeal Neuromuscular Flap Reinnervation

CPT-31592-TRACHEAL-RESECTION-PRIMARY-ANASTOMOSIS-SUBGLOTTIC-STENOSIS

CPT 31592: Tracheal Resection with Primary Anastomosis for Subglottic Stenosis

References

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.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.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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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normal, ongoing postoperative care	Use when reporting a subsequent visit related to global period care if applicable for professional component billing contexts.
`22`	Increased procedural services	Use when work required is substantially greater than typically required for this procedure.
`50`	Bilateral procedure	Use if bilateral medialization procedures are performed during the same operative session.
`51`	Multiple procedures	Use when additional unrelated procedures are performed in the same session (as permitted by payer rules).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as originally planned.
`53`	Procedure discontinued	Use when the procedure is terminated due to extenuating circumstances.
`62`	Two surgeons	Use when two surgeons from different surgical specialties work together as primary surgeons.
`66`	Surgical team	Use when a surgical team performs distinct component tasks during the procedure.
`78`	Return to operating room for a related procedure during global period	Use when a related complication requires return to OR within the global period.
`79`	Unrelated procedure or service by the same physician during global period	Use when an unrelated procedure is performed during the global period.
`LT`	Left side	Use to identify laterality when procedure is side-specific.
`RT`	Right side	Use to identify laterality when procedure is side-specific.
`22`	Increased procedural services	(listed above) — included once; use per payer guidance.

Taxonomy Code	Specialty	Notes
`207Y00000X`	Otolaryngology (ENT)	Primary specialty performing thyroplasty and laryngeal medialization.
`207L00000X`	Facial Plastic Surgery	May perform laryngeal procedures in practices focused on head and neck surgery.
`2084P0800X`	Plastic and Reconstructive Surgery	Occasionally involved when structural reconstructive expertise is required.
`207RP0000X`	Otolaryngology - Pediatric	Pediatric laryngology for congenital or pediatric neurogenic vocal fold immobility.
`363LF0000X`	Speech-Language Pathology	Provides pre- and post-procedure voice and swallow therapy (allied health taxonomy).

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J38.01`	Paralysis of vocal cords and larynx, unilateral	Common indication for medialization thyroplasty to improve glottic closure and voice.
`J38.02`	Paralysis of vocal cords and larynx, bilateral	May require medialization or alternate airway/voice strategies; bilateral cases are complex.
`R49.0`	Dysphonia	Symptom code commonly associated with vocal fold immobility prompting evaluation for medialization.
`R13.10`	Dysphagia, unspecified	Swallowing dysfunction related to incomplete glottic closure, improved by medialization.
`I69.398`	Other sequelae of cerebral infarction	Neurologic cause of vocal fold paralysis where medialization addresses symptom sequelae.
`G51.0`	Bell palsy	Cranial nerve dysfunction sometimes associated with laryngeal involvement or concurrent neuropathies.
`C80.1`	Malignant neoplasm without specification of site, metastatic	Neoplastic invasion can cause vocal fold fixation or paralysis prompting surgical intervention.
`J38.6`	Other diseases of vocal cords	Miscellaneous laryngeal disorders that may necessitate surgical medialization.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`31575`	Laryngoscopy, flexible; diagnostic	Performed preoperatively for diagnosis and visualization of vocal fold position.
`31579`	Laryngoscopy with stroboscopy	Used in voice assessment pre- and postoperatively to evaluate vibratory function.
`31625`	Laryngoplasty, open (including thyroplasty)	Related open laryngeal reconstructive techniques; sometimes used interchangeably in operative planning.
`31582`	Laryngoscopy, direct with biopsy	Performed if suspicious lesion requires tissue diagnosis prior to or during airway procedures.
`92507`	Treatment of speech and language, individual	Speech-language pathology services for postoperative voice rehabilitation and therapy.
`31595`	Laryngoplasty; other (injectable medialization)	Endoscopic or injectable augmentation techniques commonly performed instead of or in addition to open medialization.

CPT 31580: Laryngoplasty for Laryngeal Web Removal with Keel Placement

CPT-31584-LARYNGOPLASTY-REPAIR-LARYNGEAL-FRACTURE

CPT 31584: Laryngoplasty for Laryngeal Fracture

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

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

CPT-31590-LARYNGEAL-NEUROMUSCULAR-FLAP-REINNERVATION

CPT 31590: Laryngeal Neuromuscular Flap Reinnervation

CPT-31592-TRACHEAL-RESECTION-PRIMARY-ANASTOMOSIS-SUBGLOTTIC-STENOSIS

CPT 31592: Tracheal Resection with Primary Anastomosis for Subglottic Stenosis

References

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.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.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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CPT 31591: Medialization of Displaced or Paralyzed Vocal Cord

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Billing Code Overview

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CPT 31591: Medialization of Displaced or Paralyzed Vocal Cord

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References