The pyramid was built about 18–12 BC as a tomb for Gaius Cestius, a magistrate and member of one of the four great religious corporations in Rome, the Septemviri Epulonum.

[2] In the interior is the burial chamber, a simple barrel-vaulted rectangular cavity measuring 5.95 metres long, 4.10 m wide and 4.80 m high.

Until the end of restoration works in 2015, it was not possible for visitors to access the interior,[2] except by special permission typically only granted to scholars.

The work was completed, in accordance with the will, in 330 days, by the decision of the heir [Lucius] Pontus Mela, son of Publius of the Claudia, and Pothus, freedman[2] Another inscription on the east face is of modern origins, having been carved on the orders of Pope Alexander VII in 1663.

[2] At the time of its construction, the pyramid of Cestius would have stood in open countryside (tombs being forbidden within the city walls).

[5] Two marble bases were found next to the pyramid during excavations in the 1660s, complete with fragments of the bronze statues that originally had stood on their tops.

This identifies Cestius' heirs as Marcus Valerius Messala Corvinus, a famous general; Publius Rutilius Lupus, an orator whose father of the same name had been consul in 90 BC; and Lucius Junius Silanus, a member of the distinguished gens Junia.

[6] Its construction was regulated by sumptuary laws, which limit extreme displays of wealth such as in feasts, clothing, funerals, and tombs.

While these laws can be traced back to the mid-5th century BC, they were much more strictly passed and enforced around the time of Cestius’ death.

In 2011, further work was announced to clean and restore the pyramid's badly damaged marble cladding, through which water seepage has endangered the frescoes within.

The restoration is sponsored by Japanese businessman Yuzo Yagi, whose €1-million donation resulted in a call for tenders to carry out the work issued by the Soprintendenza Speciale per i Beni Archeologici di Roma[16] whose officials drew up the project and are supervising such an intervention along with Italy's Ministry of Cultural Heritage.