Summary & Overview
CPT 36261: Revision of Implanted Catheter and Infusion Pump
CPT code 36261 represents a surgical revision in which a previously placed catheter and infusion pump are accessed and either repaired or replaced. This procedure is clinically significant because it addresses device malfunction, wear, infection, or other complications that can interrupt essential infusion therapy, affecting pain management, chemotherapy delivery, or chronic condition management. Nationally, such revisions are part of ongoing device maintenance and patient safety pathways that influence hospital surgical volumes and post-implant care protocols.
Key payers included in the national analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of typical clinical indications for revision, expected sites of service, and how payers commonly categorize and process this surgical service. The publication summarizes benchmarks where available, highlights notable policy updates affecting coverage and prior authorization practices, and provides clinical context relevant to surgical teams and billing professionals. Data not available in the input is clearly marked; where payer-specific reimbursement or utilization benchmarks are not supplied, readers are informed that such data was not available in the input. The goal is to equip clinicians, billing staff, and policy analysts with a clear understanding of the procedure, administrative considerations, and areas where payer policy may affect access and documentation requirements.
Billing Code Overview
CPT code 36261 describes a surgical procedure in which a provider reopens a prior operative site to repair or replace an implanted catheter and infusion pump. This procedure involves accessing the existing pocket or catheter tract created during the original implantation to address malfunction, displacement, infection-related issues, or device replacement needs.
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Service type: Surgical revision of implanted catheter and infusion pump
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Typical site of service: Hospital operating room or ambulatory surgical center where implantable device revisions and hardware replacement are performed
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with chronic pain managed by an intrathecal infusion pump presents with malfunctioning catheter flow and increasing pain despite medication adjustments. The patient had a prior implantation of an intrathecal catheter and pump at the same abdominal/pelvic site. Imaging suggests catheter disconnection or fracture at the previous surgical site. The clinical workflow includes preoperative evaluation (history, physical, medication reconciliation), anesthesia evaluation (often monitored anesthesia care or general anesthesia), informed consent, surgical reopening of the existing incision, exploration of the pump pocket and catheter tract, repair or replacement of the catheter and/or pump hardware, intraoperative pump interrogation and programming as needed, wound closure, and postoperative recovery with short inpatient observation or same-day discharge depending on clinical status.
Typical site of service: Ambulatory surgery center or hospital outpatient surgical department, occasionally inpatient if complex or infected device.
Typical patient scenario: A patient with escalating pain and reduced intrathecal medication delivery due to catheter kinking, fracture, migration, or pump failure who requires surgical reopening of the prior implantation site to repair or replace the catheter and/or infusion pump. Postoperative plan includes device testing and pain regimen adjustment.
Coding Specifications
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