Summary & Overview
CPT 61516: Supratentorial Cyst Excision with Craniotomy
CPT code 61516 denotes an open neurosurgical procedure to remove part of the skull and excise or fenestrate a cyst located above the tentorium cerebelli. This code captures a definitive intracranial intervention for symptomatic or radiographically significant supratentorial cysts and is relevant for hospitals and surgical centers nationwide that provide neurosurgery services. It matters nationally because it reflects resource-intensive operative care, impacts facility and professional billing, and factors into procedural utilization and cost analyses for cranial neurosurgery.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, and expected service type. The publication provides benchmarks for utilization and facility-level considerations, summarizes common billing and reporting themes, and outlines policy and coding updates that affect coverage and payment practices. Where input data are not present, the report flags "Data not available in the input." The goal is to give clinicians, billing professionals, and policy analysts a concise reference for coding, classification, and payer coverage patterns related to CPT code 61516.
Billing Code Overview
CPT code 61516 describes a neurosurgical procedure in which a portion of the skull (craniectomy/craniotomy) is removed and a cyst located above the tentorium cerebelli is excised or fenestrated to permit drainage. The procedure involves intracranial access to address a cyst situated in the supratentorial compartment of the brain.
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Service type: Neurosurgical cyst excision/fenestration with cranial bone removal (open cranial procedure)
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Typical site of service: Hospital operating room or ambulatory surgical center with neurosurgical capability
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with progressive headaches, intermittent nausea, and focal neurological deficits. Brain MRI demonstrates a symptomatic supratentorial arachnoid cyst located above the tentorium cerebelli with mass effect on adjacent cortex and refractory symptoms despite conservative management. The neurosurgical team schedules a craniotomy for cyst fenestration and/or excision. Preoperative workflow includes neurosurgical consultation, informed consent detailing risks (bleeding, infection, neurologic deficit), pre-anesthesia evaluation, and perioperative imaging review. Intraoperatively, the surgeon performs a craniotomy, identifies the cyst, creates an opening or excises the cyst wall to drain cerebrospinal-like fluid and relieve mass effect. Postoperative care includes ICU or step-down monitoring for neurologic status, postoperative CT or MRI to assess decompression, pain control, and discharge planning with outpatient neurosurgical follow-up and rehabilitation as indicated. Typical site of service is an inpatient or outpatient hospital operating room; service type is operative neurosurgery (craniotomy with cyst fenestration/excision).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary surgeon | When the reporting surgeon is the primary surgeon for the procedure |