Summary & Overview
CPT 61140: Skull Biopsy for Diagnostic Tissue Sampling
Headline: CPT code 61140: Skull biopsy for diagnostic tissue sampling
Lead: CPT code 61140 denotes a neurosurgical skull biopsy procedure in which the provider drills skull openings to remove a small piece of abnormal intracranial tissue for diagnostic testing. The code captures a focused, invasive diagnostic service that influences downstream pathology, oncology, and neurosurgical care.
What the code represents and why it matters: CPT code 61140 identifies a targeted surgical biopsy of brain or adjacent intracranial tissue. As an invasive diagnostic procedure, it is integral to establishing definitive diagnoses for masses, infections, or unclear neurologic lesions and often directs significant clinical and resource decisions, including oncology treatment planning and further neurosurgical intervention.
Key payers covered: Analysis includes coverage and payment patterns from major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: This brief outlines the clinical context for use of CPT code 61140, typical sites of service, payer coverage considerations, and the types of benchmarks and policy elements that affect billing and utilization. Readers will find an overview of reimbursement themes, relevant documentation expectations, and areas where policy updates or payer edits commonly arise.
Scope: Content is written for a national audience and focuses on clinical and administrative aspects of the code, with data availability noted where input was not provided.
Billing Code Overview
CPT code 61140 describes a neurosurgical procedure in which the provider drills holes into the skull to obtain a small tissue sample for diagnostic testing. This procedure is a skull biopsy used to collect abnormal intracranial tissue for pathological evaluation.
Service type: Surgical diagnostic procedure (neurosurgery)
Typical site of service: Operating room or specialized procedure suite in a hospital or ambulatory surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with a newly identified, contrast-enhancing intracranial lesion on MRI located in the right frontal lobe with progressive focal seizures and worsening headaches. Neurosurgery and neuro-oncology recommend obtaining a tissue diagnosis to guide management. The patient is admitted to the hospital and evaluated preoperatively with neuroimaging review, coagulation studies, and informed consent. In the operating room or interventional suite under general anesthesia or monitored anesthesia care, the surgeon localizes the lesion using neuronavigation or stereotactic guidance, prepares the scalp, and creates one or more small burr holes in the skull. Through the burr hole, a stereotactic needle or forceps is advanced to the lesion and a small tissue sample is obtained for histopathology and molecular testing. Hemostasis is achieved, the wound is closed, and the specimen is sent to pathology. Typical site of service is an inpatient operating room or ambulatory surgery center with neurosurgery availability. Common immediate postoperative workflow includes recovery unit monitoring, neurologic checks, pain control, and planning for adjuvant therapy based on pathology results.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When reporting only the surgeon's professional interpretation component separate from technical facility services (rare for this surgical code). |