Summary & Overview
CPT 61458: Posterior Cranial Exploration and Cranial Nerve Decompression
CPT code 61458 represents a posterior cranial decompression and cranial nerve exploration procedure used to relieve compression of cranial nerves and treat severe neuropathic pain. The code captures a targeted neurosurgical approach where a small portion of the occipital skull is removed to access the lower posterior brain and free one or more cranial nerves. Nationally, this procedure is clinically important for patients with medically refractory cranial neuropathic pain or nerve compression syndromes and has implications for surgical capacity, perioperative resource use, and payer coverage policies.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, and the kinds of documentation and care episodes associated with the code. The publication also provides benchmarking and policy-focused content where available, including utilization patterns, coverage considerations, and common billing practice notes. If specific data elements are not present in the source input, the report indicates "Data not available in the input." This summary is written for a national audience and frames 61458 within surgical practice, care settings, and payer coverage considerations.
Billing Code Overview
CPT code 61458 describes a neurosurgical procedure in which a small portion of the skull at the back of the head is removed to access the lower posterior brain and cranial nerves. The procedure includes exploration of the lower back portion of the brain and freeing one or more cranial nerves to relieve compressive pressure that causes severe facial or cranial neuropathic pain.
Service type: Neurosurgical decompression / posterior cranial exploration and nerve decompression
Typical site of service: Inpatient or outpatient hospital operating room; specialized surgical center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 45–70 year-old adult presenting with severe, refractory facial pain consistent with trigeminal neuralgia or compressive cranial neuropathy. Symptoms include paroxysmal lancinating facial pain, cranial nerve palsies, or progressive brainstem/cranial nerve compression signs that have failed maximal medical therapy (e.g., anticonvulsants) and, when indicated, prior less-invasive interventions. Imaging (MRI with cranial nerve protocol) demonstrates vascular loop or mass effect at the cerebellopontine angle or posterior fossa compressing the affected cranial nerve(s). The neurosurgical workflow includes preoperative evaluation by a neurosurgeon and anesthesia team, informed consent, preoperative imaging review, and perioperative planning for a retrosigmoid craniotomy or microvascular decompression. In the operating room under general anesthesia, the surgeon performs a small posterior craniectomy/craniotomy to access the cerebellopontine angle, identifies the compressing structure, and frees the cranial nerve(s) (for example, microvascular decompression of the trigeminal nerve). Postoperative care involves neurologic monitoring in a post-anesthesia care unit or intensive care setting as indicated, pain control, wound care, and short inpatient observation for cranial nerve function and surgical complications. Typical site of service is an inpatient hospital operating room or ambulatory surgery center when clinically appropriate. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 |