Summary & Overview
CPT 61519: Craniectomy for Excision of Brain Tumor, Infratentorial or Posterior Fossa
CPT code 61519 is a nationally recognized billing code for craniectomy procedures targeting the excision of brain tumors in the infratentorial or posterior fossa region. This complex neurosurgical intervention is essential for managing both benign and malignant neoplasms located in the lower part of the brain, an area associated with critical neurological functions. The procedure is most commonly performed in hospital inpatient or outpatient surgical settings, reflecting the need for advanced surgical facilities and multidisciplinary care teams.
Major payers covering this procedure include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. Understanding coverage and reimbursement policies for 61519 is vital for hospitals, neurosurgeons, and healthcare administrators, as it impacts access to care and financial planning. This publication provides a comprehensive overview of the clinical context, payer coverage, and policy benchmarks relevant to 61519. Readers will gain insights into national trends, coding requirements, and the importance of this procedure in neurosurgical practice. The summary also highlights associated service types and typical sites of service, offering a clear perspective on how 61519 fits within broader healthcare delivery and billing frameworks.
CPT Code Overview
CPT code 61519 describes a craniectomy for excision of brain tumor in the infratentorial or posterior fossa region. This procedure is a form of neurosurgery typically performed in a hospital inpatient or outpatient surgical facility. The craniectomy involves removing a portion of the skull to access and excise tumors located in the lower part of the brain, which is critical for treating both benign and malignant neoplasms in this area. The complexity and location of the tumor require specialized surgical expertise and advanced hospital resources.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult or pediatric patient presenting with neurological symptoms such as headache, dizziness, ataxia, or cranial nerve deficits. Imaging studies (MRI or CT) reveal a mass in the infratentorial or posterior fossa region of the brain. The mass may be a benign or malignant neoplasm, or may be causing compression of brain structures. The neurosurgical team evaluates the patient and determines that surgical excision via craniectomy is indicated to remove the tumor and relieve symptoms. The procedure is performed in a hospital inpatient or outpatient surgical facility, often requiring multidisciplinary collaboration, such as two surgeons or an assistant surgeon.
Coding Specifications
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Modifier
62: Two Surgeons- Used when two surgeons perform distinct parts of the procedure, each acting as a primary surgeon.
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Modifier
80: Assistant Surgeon- Used when an assistant surgeon is required to help the primary surgeon during the procedure.
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