CPT 61313 Hematoma Evacuation Reimbursement | OpenPayer

Summary & Overview

CPT 61313: Frontal Hematoma Evacuation via Burr Holes

CPT code 61313 denotes a neurosurgical hematoma evacuation involving burr holes and possible skull opening to access the frontal supratentorial brain for drainage and decompression. This procedure is used to treat intracranial hematomas that raise intracranial pressure and threaten neurologic function; it is performed emergently for trauma, procedure-related bleeding, or spontaneous intracerebral hemorrhage. Nationally, accurate coding and appropriate site-of-service reporting for this high-acuity surgical intervention affect hospital case mix, emergency surgical workflows, and payer authorization processes.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, expected service setting, and which payers commonly cover the intervention. The publication also outlines where to find benchmarking and policy updates, summarizes common modifiers used with high-acuity surgical CPT codes, and highlights coding considerations relevant to billing departments and revenue cycle operations.

What readers will learn: the clinical indication and procedural scope of CPT code 61313, typical hospital-based care settings, payer coverage landscape, and guidance on locating reimbursement benchmarks and policy notices. Data not available in the input for procedure-specific national utilization rates and payer-specific fee schedules.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 61313neurosurgeryhematoma evacuationburr hole craniotomyintracranial hemorrhageacute neurosurgical carehospital inpatientsurgical codingemergency neurosurgery

Billing Code Overview

CPT code 61313 describes a neurosurgical procedure to evacuate an intracranial hematoma by creating burr holes and, if necessary, opening the skull to access the frontal supratentorial region of the brain. The procedure is performed to drain a clot and relieve elevated intracranial pressure caused by hemorrhage within the brain tissue, which can result from trauma, iatrogenic injury, or spontaneous intracerebral hemorrhage (stroke).

Service type: Neurosurgical hematoma evacuation (burr hole craniotomy / cranial decompression)
Typical site of service: Hospital operating room or emergency neurosurgical suite; inpatient setting when associated with acute intracranial hemorrhage or traumatic brain injury.

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A 68-year-old male is brought to the emergency department after a fall with loss of consciousness and progressive left-sided weakness. CT head demonstrates a symptomatic acute intracerebral hematoma with mass effect and midline shift in the right frontal lobe. The neurosurgery team evaluates the patient, obtains informed consent from the surrogate, and prepares for urgent surgical evacuation. The clinical workflow includes preoperative stabilization (airway, blood pressure control, reversal of anticoagulation if applicable), neuroimaging confirmation, operative planning, general endotracheal anesthesia, placement of burr holes and a limited craniotomy or craniectomy as indicated, microsurgical hematoma evacuation and hemostasis, intraoperative monitoring, and postoperative ICU care with repeat imaging and neurologic assessments. Typical sites of service are the hospital operating room for the procedure and the intensive care unit for postoperative management. Typical scenario drivers include traumatic brain injury, spontaneous intracerebral hemorrhage, or hemorrhagic conversion of an ischemic stroke causing mass effect and elevated intracranial pressure.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `61313` due to difficult exposure, prolonged hemostasis, or unusually challenging evacuation.

CPT 61345: Posterior Fossa Decompression (Suboccipital Craniectomy)

CPT-61544-CHOROID-PLEXUS-EXCISION-COAGULATION-NEUROSURGERY

CPT 61544: Excision or Coagulation of Choroid Plexus

CPT-61330-ORBITAL-DECOMPRESSION-FOR-PROPTOSIS-OR-FRACTURE

CPT 61330: Orbital Decompression for Proptosis or Orbital Roof Fracture

CPT-61559-CRANIAL-VAULT-REMODELING-CRANIOSYNOSTOSIS

CPT 61559: Cranial Vault Remodeling for Craniosynostosis

CPT-61458-POSTERIOR-CRANIAL-EXPLORATION-CRANIAL-NERVE-DECOMPRESSION

CPT 61458: Posterior Cranial Exploration and Cranial Nerve Decompression

CPT-61566-TEMPORAL-LOBE-MEDIAL-TEMPORAL-RESECTION-HIPPOCAMPUS-AMYGDALA

CPT 61566: Temporal Lobe Resection of Hippocampus and Amygdala

CPT-61538-TEMPORAL-LOBECTOMY-WITH-INTRAOPERATIVE-ECOG

CPT 61538: Temporal Lobectomy with Intraoperative Electrocorticography

CPT-61460-CRANIAL-NERVE-EXPOSURE-ACOUSTIC-NEUROMA

CPT 61460: Cranial Nerve Exposure for Acoustic Neuroma

CPT-61563-CRANIAL-BONE-TUMOR-RESECTION-SCALP-INCISION

CPT 61563: Cranial Bone Tumor Resection via Scalp Incision

CPT-61516-SUPRATENTORIAL-CYST-EXCISION-CRANIOTOMY

CPT 61516: Supratentorial Cyst Excision with Craniotomy

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Taxonomy Code	Specialty	Notes
208800000X	Neurosurgery	Primary specialty performing intracranial hematoma evacuation.
207L00000X	Neurological Surgery (Neurosurgeon)	Alternate taxonomy for board-certified neurosurgeons performing operative brain procedures.
2086S0122X	Critical Care Medicine	Critical care physicians manage perioperative ICU care after evacuation.
207Q00000X	Anesthesiology	Provides general endotracheal anesthesia and intraoperative monitoring for `61313`.
363LF0000X	Emergency Medicine	Initial stabilization and triage prior to operative transfer.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I61.9`	Intracerebral hemorrhage, unspecified	Direct indication for surgical hematoma evacuation when causing mass effect and neurologic deterioration.
`S06.5X0A`	Traumatic subdural hemorrhage without loss of consciousness, initial encounter	Traumatic subdural collections often require burr hole or craniotomy for evacuation.
`I62.9`	Nontraumatic intracranial hemorrhage, unspecified	Includes spontaneous intraparenchymal or subarachnoid bleeding that may necessitate evacuation.
`I60.9`	Subarachnoid hemorrhage, unspecified	SAH with localized clot causing focal mass effect may prompt neurosurgical intervention.
`I69.398`	Sequelae of intracerebral hemorrhage	Used for coding subsequent encounters related to prior hemorrhage complications and potential reoperations.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61313`	Craniectomy or craniotomy for evacuation of intracranial hematoma; supratentorial, complicated/large	Primary procedure for surgical evacuation of a supratentorial hematoma causing mass effect.
`61312`	Craniectomy or craniotomy for evacuation of intracranial hematoma; supratentorial, small or localized	May be used for smaller or more localized supratentorial hematomas when appropriate.
`61154`	Burr hole(s) for drainage of chronic subdural hematoma including catheter placement	Performed when burr hole drainage is chosen for a subdural collection rather than open craniotomy; may be an alternative technique.
`61210`	Craniectomy for trauma, decompressive craniectomy (supratentorial)	Performed when decompression rather than isolated evacuation is required for refractory intracranial hypertension after hematoma evacuation.
`99152`	Moderate sedation services provided by the same physician performing a procedure, initial 30 minutes	Used if monitored sedation (instead of general anesthesia) is employed for a limited burr hole drainage when payer allows.

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