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CPT 61323: Decompressive Craniectomy with Partial Brain Resection and Duraplasty

CPT code 61323 covers a neurosurgical decompressive craniectomy with removal of a portion of damaged brain tissue to reduce elevated intracranial pressure, and may include duraplasty to reconstruct or expand the dura. Nationally, this code represents a high-acuity, inpatient neurosurgical intervention performed in settings that manage traumatic brain injury, malignant cerebral edema, or other causes of life‑threatening intracranial hypertension. It matters because it defines a complex operative service with implications for hospital resource use, clinical outcomes, and insurer coverage determinations.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context of the procedure, typical site-of-service expectations, common billing modifiers associated with complex operative care, and where to find guidance when linking this code to diagnoses and inpatient claims. The publication also outlines benchmarks for utilization and policy considerations relevant to hospital and payer coding reviews.

This summary is intended for a national audience of clinicians, coding professionals, and policy analysts seeking a concise reference on the clinical definition and billing context for CPT code 61323.

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Billing Code Overview

CPT code 61323 describes a surgical procedure in which the provider removes a portion of the skull (craniectomy) and resects a portion of damaged brain tissue to relieve elevated intracranial pressure (ICP) by allowing the swollen brain room to expand. The procedure may include duraplasty, the reconstruction or expansion of the dura mater using a synthetic graft or the patient’s pericranium. The description explicitly excludes removal of the related hematoma.

Service type: Neurosurgical decompressive craniectomy with partial brain resection and possible duraplasty

Typical site of service: Inpatient operating room or inpatient neurosurgical unit

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CPT 61323: Decompressive Craniectomy with Partial Brain Resection and Duraplasty

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Billing Code Overview

Service type: Neurosurgical decompressive craniectomy with partial brain resection and possible duraplasty

Typical site of service: Inpatient operating room or inpatient neurosurgical unit

Clinical & Coding Specifications

Clinical Context

A 46-year-old male is brought to the emergency department after a high-speed motor vehicle collision with decreased level of consciousness and clinical signs of elevated intracranial pressure (ICP). Noncontrast head CT shows cerebral edema with midline shift without a surgically evacuable hematoma. Neurosurgery evaluates the patient and determines an urgent decompressive craniectomy with possible duraplasty is indicated to allow the swollen brain to expand and to reduce ICP. The operating room team performs general endotracheal anesthesia, positions the patient, and completes a large frontotemporoparietal hemicraniectomy. The dura is opened, nonviable brain tissue is debrided as indicated, and a duraplasty is performed using a synthetic graft to expand the dural envelope. The bone flap is typically stored for potential future cranioplasty. Postoperatively, the patient is transferred to the neurocritical care unit for intracranial pressure monitoring, ventilatory support, hemodynamic management, and serial neurologic exams. Imaging and neurological assessments guide timing of delayed cranioplasty. Documentation includes indication, preoperative neurologic status, imaging findings, specific anatomic extent of bone removal, whether duraplasty or graft was performed, whether hematoma evacuation was performed (excluded from this code), anesthesia type, complications, and disposition.

Coding Specifications

Modifier	Description	When to Use
`11`	Office or other outpatient visit	Not typically used with operative CPT; included for completeness when reporting an unrelated visit on the same day by same provider
`22`	Increased procedural services	When the procedure requires substantially greater work than typical (extensive reconstruction, prolonged operative time documented)
`23`	Unusual anesthesia	When general anesthesia is contraindicated and unusually risky regional or monitored anesthesia is used (rare for craniectomy)
`26`	Professional component	When reporting only the surgeon's professional component separate from technical services (rare for inpatient surgery)
`50`	Bilateral procedure	Not routinely applicable; use only if bilateral craniectomies are performed and payer requires bilateral modifier
`62`	Two surgeons	When two surgeons from different specialties equally share the procedure, each reports with `62` as allowed
`63`	Discontinued procedure — patient under 10	Pediatric age modifier; use when patient is under 10 and procedure was altered for age-related reasons
`78`	Return to the operating room for related procedure during postoperative period	For reoperation related to the original procedure (e.g., wound revision, hematoma evacuation) during global period
`80`	Assistant surgeon	When an assistant at surgery provides surgical services and hospital/payer requires `80` for reimbursement
`81`	Minimum assistant surgeon	When a minimal assistant surgeon role is provided
`82`	Assistant surgeon (when qualified resident not available)	When no resident is available and an assistant is required
`73`	Discontinued outpatient procedure prior to anesthesia	If the planned procedure was discontinued before anesthesia induction
`52`	Reduced services	When the procedure is partially reduced or not completed as initially planned
`53`	Discontinued procedure	When the procedure is discontinued after anesthesia induction

Taxonomy Code	Specialty	Notes
`207L00000X`	Neurological Surgery	Most common specialty performing decompressive craniectomy and duraplasty
`2084P0800X`	Critical Care Medicine	Provides intraoperative and postoperative neurocritical management; may bill critical care services
`207RC0000X`	Physician Assistant	May assist in perioperative and intraoperative care under supervising neurosurgeon
`208000000X`	Anesthesiology	Provides general anesthesia and intraoperative physiologic management
`207LP2900X`	Physical Medicine & Rehabilitation	Involved in postoperative rehabilitation planning and long-term recovery

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S06.5X0A`	Traumatic subdural hemorrhage without loss of consciousness, initial encounter	Subdural hemorrhage with mass effect or swelling may prompt decompressive craniectomy when evacuation is not primary or when diffuse edema predominates
`S06.5X2A`	Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter	Severe traumatic brain injury with intracranial hemorrhage and elevated ICP requiring decompression
`S06.2X0A`	Diffuse traumatic brain injury without loss of consciousness, initial encounter	Diffuse axonal injury or diffuse edema leading to refractory intracranial hypertension treated with decompression
`I62.9`	Nontraumatic intracranial hemorrhage, unspecified	Spontaneous hemorrhage with associated swelling and elevated ICP that may require decompressive craniectomy
`G93.2`	Benign intracranial hypertension (pseudotumor cerebri)	Rarely, in fulminant cases refractory to other therapy, surgical decompression or CSF diversion may be considered
`I61.9`	Intracerebral hemorrhage, unspecified	Large intraparenchymal hemorrhage causing mass effect and elevated ICP; decompression may be indicated if evacuation not feasible
`T90.5XXA`	Sequelae of intracranial injury, initial encounter	Used when ongoing effects of prior brain injury necessitate surgical intervention
`S06.6X0A`	Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter	SAH with severe edema and elevated ICP contributing to need for decompression

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61323`	Craniectomy, decompressive; with removal of bone flap and debridement of brain tissue (includes duraplasty if performed)	Primary procedure for medically indicated decompression of elevated intracranial pressure; excludes specific hematoma evacuation
`61312`	Craniectomy, lare temporoparietal or frontal, removal of bone flap for access to brain (not otherwise specified)	May be used for alternative craniectomy approaches or when procedure extent differs; sometimes billed for less extensive bone removal
`61520`	Craniotomy or craniectomy for excision of metastatic lesion, supratentorial	Performed when mass lesion (tumor) is the indication; delineates tumor excision rather than decompression
`61254`	Craniotomy for evacuation of hematoma, supratentorial	Used when hematoma evacuation is the primary procedure; explicitly excluded from `61323` and billed separately when performed
`61285`	Craniectomy or craniotomy with decompression for posterior fossa (suboccipital)	Related when decompression is required in posterior fossa rather than supratentorial compartments
`61790`	Brain biopsy, stereotactic or open; diagnostic tissue sampling	May be performed before or during operative planning when diagnosis is uncertain and tissue is required

CPT 61304: Supratentorial Brain Inspection via Anterior Cranial Access

CPT-61305-POSTERIOR-FOSSA-INSPECTION-SUBTENTORIAL-APPROACH

CPT 61305: Inspection of Posterior Fossa via Subtentorial Approach

CPT-61312-SUPRATENTORIAL-HEMATOMA-EVACUATION-CRANIOTOMY

CPT 61312: Supratentorial Intracranial Hematoma Evacuation

CPT-61313-FRONTAL-HEMATOMA-EVACUATION-BURR-HOLE-CRANIOTOMY

CPT 61313: Frontal Hematoma Evacuation via Burr Holes

CPT-61314-NEUROSURGICAL-HEMATOMA-EVACUATION-BURR-HOLES

CPT 61314: Neurosurgical Hematoma Evacuation, Burr Holes

CPT-61315-POSTERIOR-FOSSA-CRANIOTOMY-HEMATOMA-EVACUATION

CPT 61315: Posterior Fossa Craniotomy for Cerebellar Hematoma Evacuation

CPT-61316-CRANIAL-BONE-GRAFT-POCKETING-TEMPORARY-ABDOMINAL-STORAGE

CPT 61316: Temporary Subcutaneous Cranial Bone Graft Pocketing

CPT-61320-INTRACRANIAL-ABSCESS-DRAINAGE-SUPRATENTORIAL

CPT 61320: Supratentorial Intracranial Abscess Drainage

CPT-61321-CRANIAL-ABSCESS-DRAINAGE

CPT 61321: Cranial Drainage of Brain Abscess

CPT-61322-DECOMPRESSIVE-CRANIECTOMY-DURAPLASTY

CPT 61322: Decompressive Craniectomy with Possible Duraplasty

Showing 1–10 of 62

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`	Office or other outpatient visit	Not typically used with operative CPT; included for completeness when reporting an unrelated visit on the same day by same provider
`22`	Increased procedural services	When the procedure requires substantially greater work than typical (extensive reconstruction, prolonged operative time documented)
`23`	Unusual anesthesia	When general anesthesia is contraindicated and unusually risky regional or monitored anesthesia is used (rare for craniectomy)
`26`	Professional component	When reporting only the surgeon's professional component separate from technical services (rare for inpatient surgery)
`50`	Bilateral procedure	Not routinely applicable; use only if bilateral craniectomies are performed and payer requires bilateral modifier
`62`	Two surgeons	When two surgeons from different specialties equally share the procedure, each reports with `62` as allowed
`63`	Discontinued procedure — patient under 10	Pediatric age modifier; use when patient is under 10 and procedure was altered for age-related reasons
`78`	Return to the operating room for related procedure during postoperative period	For reoperation related to the original procedure (e.g., wound revision, hematoma evacuation) during global period
`80`	Assistant surgeon	When an assistant at surgery provides surgical services and hospital/payer requires `80` for reimbursement
`81`	Minimum assistant surgeon	When a minimal assistant surgeon role is provided
`82`	Assistant surgeon (when qualified resident not available)	When no resident is available and an assistant is required
`73`	Discontinued outpatient procedure prior to anesthesia	If the planned procedure was discontinued before anesthesia induction
`52`	Reduced services	When the procedure is partially reduced or not completed as initially planned
`53`	Discontinued procedure	When the procedure is discontinued after anesthesia induction

Taxonomy Code	Specialty	Notes
`207L00000X`	Neurological Surgery	Most common specialty performing decompressive craniectomy and duraplasty
`2084P0800X`	Critical Care Medicine	Provides intraoperative and postoperative neurocritical management; may bill critical care services
`207RC0000X`	Physician Assistant	May assist in perioperative and intraoperative care under supervising neurosurgeon
`208000000X`	Anesthesiology	Provides general anesthesia and intraoperative physiologic management
`207LP2900X`	Physical Medicine & Rehabilitation	Involved in postoperative rehabilitation planning and long-term recovery

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S06.5X0A`	Traumatic subdural hemorrhage without loss of consciousness, initial encounter	Subdural hemorrhage with mass effect or swelling may prompt decompressive craniectomy when evacuation is not primary or when diffuse edema predominates
`S06.5X2A`	Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter	Severe traumatic brain injury with intracranial hemorrhage and elevated ICP requiring decompression
`S06.2X0A`	Diffuse traumatic brain injury without loss of consciousness, initial encounter	Diffuse axonal injury or diffuse edema leading to refractory intracranial hypertension treated with decompression
`I62.9`	Nontraumatic intracranial hemorrhage, unspecified	Spontaneous hemorrhage with associated swelling and elevated ICP that may require decompressive craniectomy
`G93.2`	Benign intracranial hypertension (pseudotumor cerebri)	Rarely, in fulminant cases refractory to other therapy, surgical decompression or CSF diversion may be considered
`I61.9`	Intracerebral hemorrhage, unspecified	Large intraparenchymal hemorrhage causing mass effect and elevated ICP; decompression may be indicated if evacuation not feasible
`T90.5XXA`	Sequelae of intracranial injury, initial encounter	Used when ongoing effects of prior brain injury necessitate surgical intervention
`S06.6X0A`	Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter	SAH with severe edema and elevated ICP contributing to need for decompression

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61323`	Craniectomy, decompressive; with removal of bone flap and debridement of brain tissue (includes duraplasty if performed)	Primary procedure for medically indicated decompression of elevated intracranial pressure; excludes specific hematoma evacuation
`61312`	Craniectomy, lare temporoparietal or frontal, removal of bone flap for access to brain (not otherwise specified)	May be used for alternative craniectomy approaches or when procedure extent differs; sometimes billed for less extensive bone removal
`61520`	Craniotomy or craniectomy for excision of metastatic lesion, supratentorial	Performed when mass lesion (tumor) is the indication; delineates tumor excision rather than decompression
`61254`	Craniotomy for evacuation of hematoma, supratentorial	Used when hematoma evacuation is the primary procedure; explicitly excluded from `61323` and billed separately when performed
`61285`	Craniectomy or craniotomy with decompression for posterior fossa (suboccipital)	Related when decompression is required in posterior fossa rather than supratentorial compartments
`61790`	Brain biopsy, stereotactic or open; diagnostic tissue sampling	May be performed before or during operative planning when diagnosis is uncertain and tissue is required

CPT 61304: Supratentorial Brain Inspection via Anterior Cranial Access

CPT-61305-POSTERIOR-FOSSA-INSPECTION-SUBTENTORIAL-APPROACH

CPT 61305: Inspection of Posterior Fossa via Subtentorial Approach

CPT-61312-SUPRATENTORIAL-HEMATOMA-EVACUATION-CRANIOTOMY

CPT 61312: Supratentorial Intracranial Hematoma Evacuation

CPT-61313-FRONTAL-HEMATOMA-EVACUATION-BURR-HOLE-CRANIOTOMY

CPT 61313: Frontal Hematoma Evacuation via Burr Holes

CPT-61314-NEUROSURGICAL-HEMATOMA-EVACUATION-BURR-HOLES

CPT 61314: Neurosurgical Hematoma Evacuation, Burr Holes

CPT-61315-POSTERIOR-FOSSA-CRANIOTOMY-HEMATOMA-EVACUATION

CPT 61315: Posterior Fossa Craniotomy for Cerebellar Hematoma Evacuation

CPT-61316-CRANIAL-BONE-GRAFT-POCKETING-TEMPORARY-ABDOMINAL-STORAGE

CPT 61316: Temporary Subcutaneous Cranial Bone Graft Pocketing

CPT-61320-INTRACRANIAL-ABSCESS-DRAINAGE-SUPRATENTORIAL

CPT 61320: Supratentorial Intracranial Abscess Drainage

CPT-61321-CRANIAL-ABSCESS-DRAINAGE

CPT 61321: Cranial Drainage of Brain Abscess

CPT-61322-DECOMPRESSIVE-CRANIECTOMY-DURAPLASTY

CPT 61322: Decompressive Craniectomy with Possible Duraplasty

Showing 1–10 of 62

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 61323: Decompressive Craniectomy with Partial Brain Resection and Duraplasty

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Billing Code Overview

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CPT 61323: Decompressive Craniectomy with Partial Brain Resection and Duraplasty

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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