Summary & Overview
CPT 61460: Cranial Nerve Exposure for Acoustic Neuroma
CPT code 61460 denotes an open surgical approach to the upper posterior neck to expose and free cranial nerves, most commonly used in the management of vestibular schwannoma (acoustic neuroma). Nationally, this procedure is significant because it involves complex skull base and neuro-otologic surgical care with implications for functional outcomes in hearing and balance, perioperative risk, and post-acute rehabilitation needs. Payers commonly engaged in coverage and payment for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for CPT code 61460, expected sites of service, and the typical service type. The publication presents payer coverage considerations and commonly applied procedural modifiers. It also summarizes benchmarking metrics and policy-relevant updates affecting billing and reimbursement for cranial nerve exposure procedures. Clinical implications, coding nuances, and areas where input data were not provided are noted to help clinical coders, hospital billing teams, and policy analysts understand where further documentation or review may be needed.
Billing Code Overview
CPT code 61460 describes a surgical procedure in which the provider makes an incision in the upper posterior neck to expose and free one or more cranial nerves. This operation is typically performed to treat a vestibular schwannoma (acoustic neuroma), a benign tumor affecting nerves connecting the brain to the inner ear that control balance and hearing.
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Service type: Open cranial nerve decompression/exposure for tumor resection
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Typical site of service: Inpatient or outpatient surgical suite depending on complexity and patient factors
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with progressive unilateral hearing loss, tinnitus, and intermittent imbalance. MRI of the internal auditory canals demonstrates a 2.5 cm enhancing mass consistent with a vestibular schwannoma (acoustic neuroma) arising from the vestibulocochlear nerve. After multidisciplinary tumor board review, the neurosurgeon and neuro-otologist plan a retrosigmoid craniotomy with microsurgical decompression and nerve-sparing tumor resection. The operative workflow includes general endotracheal anesthesia, neuronavigation setup, intraoperative neuromonitoring of cranial nerves V, VII, VIII, and lower cranial nerves as indicated, a posterior fossa skin incision in the upper neck/occipital region, suboccipital bone removal, dural opening, tumor microsurgical dissection from the cranial nerve(s), and hemostasis with closure. Postoperative care includes ICU or step-down monitoring for neurologic status, serial cranial nerve assessments (hearing, facial movement), pain control, and early physical therapy for balance rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons work together as primary surgeons performing distinct portions of the procedure. |
80 |