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CPT 61026: Ventricular Needle Access for Diagnostic or Therapeutic CSF Procedures

CPT code 61026 covers needle access to a cerebral ventricle to inject diagnostic or therapeutic agents, measure intracranial pressure, remove excess cerebrospinal fluid, or collect cerebrospinal fluid for laboratory analysis. This targeted ventricular access procedure is an important tool in the diagnosis and management of neurological conditions such as central nervous system infection, hydrocephalus, and intracranial pressure abnormalities. Nationwide, accurate coding of this service affects clinical documentation, inpatient and outpatient billing workflows, and case-mix reporting in neurosurgical care.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of clinical context, typical sites of service, and common modifiers associated with reporting this procedure. The publication provides benchmarks and coding guidance context relevant to billing professionals and policy analysts, including how the procedure is characterized for reimbursement and quality measurement. It also highlights policy and coverage considerations that influence prior authorization, site-of-service determinations, and documentation standards. Data not available in the input is noted where applicable.

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Billing Code Overview

CPT code 61026 describes a neurosurgical ventricular access procedure in which a provider inserts a needle into one of the brain’s ventricles to inject a diagnostic or therapeutic agent. The service may be performed through a previously created burr hole, the fontanelle, a coronal suture, or via an existing internal ventricular drain. Indications include measuring intracranial pressure, removing excess cerebrospinal fluid, collecting fluid samples for diagnosis (for example, to evaluate suspected meningitis), or delivering intraventricular medications.

Service type: Procedural neurosurgical ventricular access for diagnostic or therapeutic cerebrospinal fluid manipulation
Typical site of service: Inpatient hospital or ambulatory surgical setting where neurosurgical procedures and cerebrospinal fluid access are performed (e.g., operating room, procedure suite, or intensive care unit)

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CPT 61026: Ventricular Needle Access for Diagnostic or Therapeutic CSF Procedures

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Billing Code Overview

Service type: Procedural neurosurgical ventricular access for diagnostic or therapeutic cerebrospinal fluid manipulation
Typical site of service: Inpatient hospital or ambulatory surgical setting where neurosurgical procedures and cerebrospinal fluid access are performed (e.g., operating room, procedure suite, or intensive care unit)

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents to the neurosurgery service with fever, headache, neck stiffness, and altered mental status. The admitting team suspects central nervous system infection after recent placement of an external ventricular drain for hydrocephalus following subarachnoid hemorrhage. The neurosurgeon performs ventricular needle aspiration and injection through an existing burr hole or the external ventricular drain to obtain cerebrospinal fluid (CSF) for culture and cell count, relieve elevated intracranial pressure, and instill intraventricular antibiotics if indicated. The clinical workflow includes verification of prior cranial access (burr hole or drain), informed consent, sterile preparation at the bedside or in the operating room, image guidance or landmark confirmation as needed, placement of a ventricular needle through the existing access, withdrawal of CSF and/or measurement of opening pressure, possible instillation of medication, documentation of volumes and pressures, and handoff to the critical care team for post-procedure monitoring.

Coding Specifications

Modifier	Description	When to Use
`11`	Unusual procedural services (modifier -24 indicates unrelated E/M; `11` is CMS internal — use `22` for increased procedural services)	Not typically used; omitted if not applicable.
`22`	Increased procedural services	Use when the procedure requires substantially greater work than usual due to complexity, extensive adhesions, or difficult access through scarred tissue.
`23`	Unusual anesthesia	Use if general anesthesia is required for an otherwise routine procedure because patient condition necessitates it.
`50`	Bilateral procedure	Rarely applicable; use if ventricular access is performed bilaterally in the same session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is stopped before completion for patient-related or clinical reasons.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure from other services on the same day (e.g., separate ventricular access distinct from another cranial procedure).
`62`	Two surgeons	Use when two surgeons of different specialties are required to perform the procedure collaboratively.
`63`	Procedure performed on infants less than 4 kg	Use for neonates meeting weight criteria when applicable.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when a different physician repeats the procedure the same day.
`78`	Unplanned return to the operating/procedure room for a related procedure following initial service	Use when the patient returns to the OR/procedure room the same day or shortly thereafter for a complication or related issue.
`80`	Assistant surgeon	Use when an assistant surgeon is required and reimbursable.
`TC`	Technical component	Use when reporting only the technical component of the service (if applicable in split billing scenarios).

Taxonomy Code	Specialty	Notes
`207RH0000X`	Neurological Surgery	Primary specialty performing intracranial ventricular access and drainage procedures.
`207RI0001X`	Interventional Neuroradiology	Performs image-guided ventricular access in select cases.
`363L00000X`	Critical Care Medicine	May perform bedside ventricular access in ICU settings in certain systems or manage post-procedure care.
`208000000X`	Emergency Medicine	May be involved in emergent bedside ventricular puncture in unstable patients.
`207L00000X`	Neurology	May be involved in diagnostic intraventricular injections for diagnostic purposes but less commonly the proceduralist.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G00.9`	Bacterial meningitis, unspecified	Represents suspected or confirmed CNS infection prompting CSF sampling and intraventricular antibiotic administration.
`G03.9`	Meningitis, unspecified	Used when meningitis is suspected and diagnostic CSF sampling via ventricular access is performed.
`I62.9`	Nontraumatic intracranial hemorrhage, unspecified	Post-hemorrhagic hydrocephalus may require ventricular access for drainage and pressure management.
`G91.2`	Hydrocephalus due to other specified causes	Ventricular needle access may be used for pressure measurement, temporary CSF removal, or therapeutic injections.
`T85.39XA`	Mechanical complication of other long-term internal device, implant and graft, initial encounter	Used when complications related to an external ventricular drain necessitate needle access via the drain for sampling or management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61026`	Insertion of needle into ventricular system for diagnostic/therapeutic purposes through existing burr hole, fontanelle, coronal suture, or internal ventricular drain	Primary procedure for ventricular needle access, CSF sampling, pressure measurement, drainage, or intraventricular medication administration.
`62190`	Puncture aspiration of intracranial cyst or abscess, simple	May be performed when focal intraparenchymal collections require aspiration distinct from ventricular access.
`61105`	Extraventricular reservoir placement (Ommaya reservoir)	Performed before or instead of repeated ventricular needle access to facilitate serial CSF sampling or drug administration.
`43200`	Diagnostic lumbar puncture (spinal tap)	Alternative CSF sampling procedure; may be performed if ventricular access is not indicated.
`95816`	Intracranial pressure monitoring, insertion of catheter (epidural or subarachnoid)	Complementary procedure when continuous ICP monitoring is required alongside intermittent ventricular access.

CPT 61000: Initial Dural Puncture Through Fontanelle or Coronal Suture

CPT-61001-INFANT-FONTANELLE-DURAL-PUNCTURE-DRAINAGE

CPT 61001: Subsequent Dural Puncture/Drainage via Fontanelle or Coronal Suture

CPT-61020-VENTRICULAR-CSF-ASPIRATION-WITHOUT-INJECTION

CPT 61020: Ventricular CSF Aspiration Without Injection

CPT-61050-CISTERNAL-OR-LATERAL-CERVICAL-PUNCTURE-CSF-ACCESS

CPT 61050: Cisternal or Lateral Cervical Puncture for CSF Access

CPT-61055-OCCIPITOATLANTAL-ATLANTOAXIAL-JOINT-INJECTION

CPT 61055: Occipitoatlantal / Atlantoaxial Joint Injection

CPT-61070-SHUNT-TAP-CSF-ACCESS-AND-PRESSURE-ASSESSMENT

CPT 61070: Shunt Tap for CSF Access and Pressure Assessment

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Unusual procedural services (modifier -24 indicates unrelated E/M; `11` is CMS internal — use `22` for increased procedural services)	Not typically used; omitted if not applicable.
`22`	Increased procedural services	Use when the procedure requires substantially greater work than usual due to complexity, extensive adhesions, or difficult access through scarred tissue.
`23`	Unusual anesthesia	Use if general anesthesia is required for an otherwise routine procedure because patient condition necessitates it.
`50`	Bilateral procedure	Rarely applicable; use if ventricular access is performed bilaterally in the same session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned.
`53`	Discontinued procedure	Use when the procedure is stopped before completion for patient-related or clinical reasons.
`59`	Distinct procedural service	Use to indicate a separate and distinct procedure from other services on the same day (e.g., separate ventricular access distinct from another cranial procedure).
`62`	Two surgeons	Use when two surgeons of different specialties are required to perform the procedure collaboratively.
`63`	Procedure performed on infants less than 4 kg	Use for neonates meeting weight criteria when applicable.
`76`	Repeat procedure by same physician	Use when the same physician repeats the procedure later the same day.
`77`	Repeat procedure by another physician	Use when a different physician repeats the procedure the same day.
`78`	Unplanned return to the operating/procedure room for a related procedure following initial service	Use when the patient returns to the OR/procedure room the same day or shortly thereafter for a complication or related issue.
`80`	Assistant surgeon	Use when an assistant surgeon is required and reimbursable.
`TC`	Technical component	Use when reporting only the technical component of the service (if applicable in split billing scenarios).

Taxonomy Code	Specialty	Notes
`207RH0000X`	Neurological Surgery	Primary specialty performing intracranial ventricular access and drainage procedures.
`207RI0001X`	Interventional Neuroradiology	Performs image-guided ventricular access in select cases.
`363L00000X`	Critical Care Medicine	May perform bedside ventricular access in ICU settings in certain systems or manage post-procedure care.
`208000000X`	Emergency Medicine	May be involved in emergent bedside ventricular puncture in unstable patients.
`207L00000X`	Neurology	May be involved in diagnostic intraventricular injections for diagnostic purposes but less commonly the proceduralist.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`G00.9`	Bacterial meningitis, unspecified	Represents suspected or confirmed CNS infection prompting CSF sampling and intraventricular antibiotic administration.
`G03.9`	Meningitis, unspecified	Used when meningitis is suspected and diagnostic CSF sampling via ventricular access is performed.
`I62.9`	Nontraumatic intracranial hemorrhage, unspecified	Post-hemorrhagic hydrocephalus may require ventricular access for drainage and pressure management.
`G91.2`	Hydrocephalus due to other specified causes	Ventricular needle access may be used for pressure measurement, temporary CSF removal, or therapeutic injections.
`T85.39XA`	Mechanical complication of other long-term internal device, implant and graft, initial encounter	Used when complications related to an external ventricular drain necessitate needle access via the drain for sampling or management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61026`	Insertion of needle into ventricular system for diagnostic/therapeutic purposes through existing burr hole, fontanelle, coronal suture, or internal ventricular drain	Primary procedure for ventricular needle access, CSF sampling, pressure measurement, drainage, or intraventricular medication administration.
`62190`	Puncture aspiration of intracranial cyst or abscess, simple	May be performed when focal intraparenchymal collections require aspiration distinct from ventricular access.
`61105`	Extraventricular reservoir placement (Ommaya reservoir)	Performed before or instead of repeated ventricular needle access to facilitate serial CSF sampling or drug administration.
`43200`	Diagnostic lumbar puncture (spinal tap)	Alternative CSF sampling procedure; may be performed if ventricular access is not indicated.
`95816`	Intracranial pressure monitoring, insertion of catheter (epidural or subarachnoid)	Complementary procedure when continuous ICP monitoring is required alongside intermittent ventricular access.

CPT 61000: Initial Dural Puncture Through Fontanelle or Coronal Suture

CPT-61001-INFANT-FONTANELLE-DURAL-PUNCTURE-DRAINAGE

CPT 61001: Subsequent Dural Puncture/Drainage via Fontanelle or Coronal Suture

CPT-61020-VENTRICULAR-CSF-ASPIRATION-WITHOUT-INJECTION

CPT 61020: Ventricular CSF Aspiration Without Injection

CPT-61050-CISTERNAL-OR-LATERAL-CERVICAL-PUNCTURE-CSF-ACCESS

CPT 61050: Cisternal or Lateral Cervical Puncture for CSF Access

CPT-61055-OCCIPITOATLANTAL-ATLANTOAXIAL-JOINT-INJECTION

CPT 61055: Occipitoatlantal / Atlantoaxial Joint Injection

CPT-61070-SHUNT-TAP-CSF-ACCESS-AND-PRESSURE-ASSESSMENT

CPT 61070: Shunt Tap for CSF Access and Pressure Assessment

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 61026: Ventricular Needle Access for Diagnostic or Therapeutic CSF Procedures

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Billing Code Overview

OpenPayer

CPT 61026: Ventricular Needle Access for Diagnostic or Therapeutic CSF Procedures

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References