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.
| Taxonomy Code | Specialty Name |
|---|---|
207T00000X | Neurological Surgery |
208600000X | Surgery |
207ZP0102X | Pediatric Neurosurgery |
- Neurological Surgery: Specialists in surgical treatment of disorders of the nervous system.
- Surgery: General surgeons who may assist or collaborate in complex neurosurgical cases.
- Pediatric Neurosurgery: Specialists focused on neurosurgical care for pediatric patients.
Related Diagnoses
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D32.0: Benign neoplasm of cerebral meninges- Indicates a benign tumor affecting the meninges, which may require surgical excision if located in the posterior fossa.
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C71.6: Malignant neoplasm of cerebellum- Represents a cancerous tumor in the cerebellum, often necessitating craniectomy for removal.
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D33.1: Benign neoplasm of brain, infratentorial- Refers to a benign tumor in the infratentorial region, a common indication for this procedure.
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G93.5: Compression of brain- Used when a mass effect from a tumor or other lesion is causing compression of brain structures, justifying surgical intervention.
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R47.01: Aphasia- Indicates loss of language function, which may be a presenting symptom due to tumor location or mass effect in the posterior fossa.
Related CPT Codes
61520: Craniectomy for excision of brain tumor, infratentorial or posterior fossa (e.g., acoustic neuroma)
61520 is closely related to 61519 and may be used as an alternative depending on the specific tumor type, such as acoustic neuroma. Both codes describe craniectomy procedures in the infratentorial or posterior fossa region. These codes are not typically used together in the same encounter but may be selected based on the clinical diagnosis and surgical approach.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 61519 under Medicare is $2,815.49, while the average commercial benchmark (BUCA) is $3,821.75. Commercial payers such as UnitedHealth Group and Cigna report even higher mean rates, at $5,317.24 and $4,865.13 respectively, with Blue Cross Blue Shield at $3,566.08 and Aetna at $2,319.53.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare shows the tightest range ($302.00), indicating relatively consistent rates. In contrast, UnitedHealth Group exhibits the widest spread ($3,053.50), followed by Cigna ($2,772.00) and Blue Cross Blue Shield ($1,737.50), reflecting greater variability in commercial reimbursement.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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