Summary & Overview
CPT 69740: Suture of Facial Nerve in Middle Ear, With/Without Graft
CPT code 69740 denotes surgical suture of the facial nerve performed lateral to the geniculate ganglion in the middle ear, and may include nerve grafting or decompression. This microsurgical otologic procedure is used to repair facial nerve injury or pathology where precision under an operating microscope is required. Nationally, procedures coded with 69740 are clinically significant due to their role in restoring facial nerve function and preventing long-term morbidity.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the clinical context for the code, typical sites of service, and the payer mix commonly involved in coverage decisions. The publication outlines relevant benchmarks and policy considerations affecting reimbursement and coding consistency for microsurgical facial nerve repair. It also highlights coding scope — that 69740 covers primary suture repair with or without graft or decompression in the middle ear — and notes where additional services or settings may require separate coding.
This analysis is written for a national audience and aims to clarify the clinical and billing definition of 69740, summarize who pays for these services, and indicate what readers can expect in terms of policy and coding guidance when reviewing claims or preparing documentation.
Billing Code Overview
CPT code 69740 describes surgical repair of the facial nerve performed to the side of the geniculate ganglion in the middle ear. The procedure includes suture of a facial nerve and may be performed with or without a nerve graft or nerve decompression. Service type: Surgical procedure under the Surgery/Operating Microscope section. Typical site of service: Hospital operating room or ambulatory surgery center involving middle ear surgery.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting with complete or partial facial paralysis following temporal bone trauma, iatrogenic injury during otologic surgery, or progressive facial nerve dysfunction from a tumor or chronic compression. The patient undergoes evaluation by an otolaryngologist—often with neurotology subspecialty—who performs clinical facial nerve grading (House-Brackmann), audiologic testing, and high-resolution temporal bone CT and/or MRI to localize the lesion to the segment proximal to the stylomastoid foramen and at or near the geniculate ganglion in the middle ear. When direct primary repair, grafting, or decompression of the facial nerve at the geniculate ganglion is indicated, the surgical team performs a middle ear approach under operating microscope visualization and documents indication, operative findings, laterality, technique (suture repair, interposition nerve graft, or decompression), estimated blood loss, anesthesia type, and complications. Typical site of service is an inpatient or outpatient hospital operating room or ambulatory surgery center equipped for otologic microsurgery. Typical service type is surgery using an operating microscope for facial nerve suture, repair with or without graft or decompression. The clinical workflow includes preoperative consent and imaging review, intraoperative facial nerve monitoring, microsurgical exposure of the geniculate ganglion region, nerve repair (with or without graft), hemostasis, closure, and postoperative monitoring with facial nerve function follow-up and rehabilitation planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 |