CPT 61154 Burr‑Hole Hematoma Reimbursement | OpenPayer

Summary & Overview

CPT 61154: Burr-Hole Evacuation of Intracranial Hematoma

CPT code 61154 denotes a neurosurgical burr‑hole procedure to drain or evacuate an intracranial hematoma located on or beneath the dura. The code captures emergent or urgent interventions to relieve intracranial pressure and remove blood collections resulting from trauma or iatrogenic injury. Nationally, accurate use of this code matters for clinical documentation, operative reporting, and hospital billing for high‑acuity neurosurgical care.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for the procedure, typical sites of service, and the operational importance of correct code selection. The publication also summarizes common modifiers used with high‑acuity surgical CPT codes and highlights benchmarking and policy considerations relevant to payers and hospital billing teams.

This summary is intended to orient clinicians, coding professionals, and payers to the purpose and clinical setting of CPT code 61154, and to preview the types of benchmarks, reimbursement considerations, and documentation elements addressed in the full publication. Data not available in the input where applicable will be noted within detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 61154neurosurgeryhematoma evacuationburr holesurgical procedurehospital inpatientemergency neurosurgeryoperative coding

Billing Code Overview

CPT code 61154 describes a neurosurgical procedure in which the provider drills one or more holes in the skull to drain or evacuate a hematoma located on the surface of, or beneath, the dura mater. This procedure is performed to remove a collection of blood that has accumulated as a result of trauma or a medical procedure and that requires urgent decompression.

Service type: Neurosurgical hematoma evacuation via burr hole(s)
Typical site of service: Hospital inpatient or emergency department transitioning to the operating room; may also occur in acute care surgical settings when emergent neurosurgical access is required.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents to the emergency department after a fall with acute headache, declining mental status, and a focal neurologic deficit. Head CT demonstrates a symptomatic acute subdural hematoma with midline shift. Neurosurgery evaluates the patient, obtains informed consent from the surrogate, and prepares for urgent operative evacuation. In the operating room under general anesthesia, the neurosurgeon performs a burr hole craniostomy (drilling one or more burr holes through the skull) to evacuate the subdural hematoma and achieve hemostasis. Postoperatively the patient is transferred to the intensive care unit for neurologic monitoring, repeat imaging, and management of intracranial pressure.

A typical workflow includes:

Initial evaluation in ED with neurologic exam and non-contrast head CT
Neurosurgical consultation and operative consent
Preoperative anesthesia evaluation and perioperative optimization
Operating room procedure: positioning, sterile prep, creation of burr hole(s), evacuation/irrigation of hematoma, placement of drainage if indicated
Immediate postoperative head CT as clinically indicated and ICU admission for neurologic observation
Documentation elements required: indication, laterality, number of burr holes, estimated blood loss, complications, type of anesthesia, and postprocedure disposition.

Coding Specifications

CPT 61210: Cranial Access for Ventricular Drainage and Monitoring

CPT-61250-SUPRATENTORIAL-BURR-HOLE-EXPLORATION

CPT 61250: Supratentorial Burr Hole Exploration, Diagnostic

CPT-61105-SKULL-DRILL-VENTRICULAR-SUBDURAL-FLUID-DRAINAGE

CPT 61105: Skull Opening for Ventricular or Subdural Fluid Drainage

CPT-61150-INTRACRANIAL-ABSCESS-CYST-DRAINAGE

CPT 61150: Surgical Drainage of Brain Abscess or Cyst

CPT-61151-BRAIN-ABSCESS-CYST-ASPIRATION-THROUGH-ESTABLISHED-BURR-HOLE

CPT 61151: Aspiration of Brain Abscess or Cyst via Established Burr Hole

CPT-61107-BURR-HOLE-CRANIAL-ACCESS-INTRACRANIAL-DRAINAGE-MONITORING

CPT 61107: Burr-Hole Cranial Access for Intracranial Drainage/Monitoring

CPT-61140-SKULL-BIOPSY-DRILLING-FOR-TISSUE-SAMPLE

CPT 61140: Skull Biopsy for Diagnostic Tissue Sampling

CPT-61156-BURR-HOLE-ASPIRATION-INTRACRANIAL-CYST-HEMATOMA

CPT 61156: Burr-Hole Aspiration of Intracranial Cyst or Hematoma

CPT-61108-CRANIAL-HEMATOMA-EVACUATION-BURR-HOLES

CPT 61108: Cranial Hematoma Evacuation (Burr Holes)

CPT-61253-INFRATENTORIAL-BURR-HOLE-INSPECTION

CPT 61253: Infratentorial Burr Hole Brain Inspection

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Taxonomy Code	Specialty	Notes
207RH0000X	Neurological Surgery	Primary specialty performing burr hole craniostomy and hematoma evacuation.
2084P0800X	Emergency Medicine	Responsible for initial evaluation, stabilization, and obtaining emergent neurosurgical consultation.
207L00000X	Anesthesiology	Provides intraoperative anesthesia management for emergent neurosurgical procedures.
208000000X	Hospitalist/Internal Medicine	Manages perioperative medical optimization and postoperative inpatient care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S06.5X0A`	Traumatic subdural hemorrhage without loss of consciousness, initial encounter	Acute subdural hematoma is a primary indication for burr hole evacuation when producing mass effect or neurologic decline.
`S06.5X1A`	Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter	Indicates subdural hemorrhage with LOC; may prompt urgent surgical evacuation via burr hole(s).
`I62.0`	Nontraumatic subdural hemorrhage	Spontaneous subdural collections (e.g., anticoagulation-related) that require evacuation with burr holes.
`S06.4X0A`	Epidural hemorrhage without loss of consciousness, initial encounter	Acute epidural hematoma may be evacuated via burr hole(s) in emergent settings.
`I62.1`	Nontraumatic extradural hemorrhage	Nontraumatic epidural/extradural collections that may require surgical drainage.
`S06.2X0A`	Traumatic focal brain injury (contusion) without loss of consciousness, initial encounter	Associated contusion with mass effect sometimes requires burr hole drainage if associated hemorrhagic collections.
`T79.A1XA`	Traumatic intracranial hemorrhage due to injury, initial encounter	General code for intracranial hemorrhage post-injury relevant to indication for evacuation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61154`	Burr hole(s) for drainage or evacuation of hematoma (subdural/epidural)	Primary procedure to access and evacuate intracranial hematoma; the focal billing code for this service.
`61618`	Stereotactic surgical procedure; for aspiration of hematoma or abscess	May be used when a stereotactic-guided aspiration is performed instead of or in addition to burr hole evacuation.
`61210`	Craniectomy or craniotomy for evacuation of hematoma; subdural or epidural (simple)	Used when a larger craniotomy or craniectomy is performed instead of burr hole(s) for definitive evacuation.
`61105`	Trephination or burr hole(s) without drainage	Related code for diagnostic or pressure-relieving burr holes where no significant evacuation is performed.
`99140`	Anesthesia for procedures on the head and neck (add-on) — (Note: verify payer-specific anesthesia coding)	May be reported by anesthesia providers for intraoperative management during neurosurgical burr hole procedures.

`00`	No modifier — billed as primary service	Use when no special modifier applies and claim represents the standard service.
`11`	Office/Outpatient? (Note: `11` is not a standard CMS modifier; if present in billing systems it may indicate primary procedure)	Use only if local payer uses `11` to indicate primary service per their guidelines.
`22`	Increased procedural services	Use when work or time substantially exceeds usual for `61154` and documentation supports increased complexity.
`23`	Unusual anesthesia for surgery	Use when general anesthesia is not used and the anesthesia is unusually extensive for a minor procedure, per payer rules.
`26`	Professional component	Use when only the professional surgical component is billed separate from a facility or technical component.
`50`	Bilateral procedure	Use when burr holes/evacuation are performed on both sides and payer allows bilateral reporting.
`51`	Multiple procedures	Use when `61154` is performed in the same operative session with other distinct procedures and payer requires modifier for additional procedures.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned and documentation explains why.
`53`	Discontinued procedure	Use when the procedure is terminated due to extenuating circumstances after anesthesia induction.
`59`	Distinct procedural service	Use when `61154` represents a distinct and separate service from other procedures on same date (alternate to more specific modifiers).

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