Summary & Overview
CPT 61518: Excision of Infratentorial/Posterior Fossa Brain Tumor
Headline: CPT code 61518: Infratentorial/Posterior Fossa Craniectomy for Tumor Excision
Lead: CPT code 61518 identifies an open neurosurgical procedure to remove part of the skull and excise a tumor located beneath the tentorium cerebelli or within the posterior fossa. The code applies to non-meningioma and non–cerebellopontine angle lesions and is used primarily in inpatient hospital operative settings.
CPT code 61518 represents a high-acuity neurosurgical intervention with national significance due to the complexity of posterior fossa anatomy and potential for substantial resource use, surgical risk, and post-operative care. The code captures operative management of infratentorial brain tumors that require craniectomy and direct excision.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context about the procedure, typical sites of service, commonly associated diagnoses, and related CPT codes to inform coding alignment. The publication also highlights billing considerations such as common modifiers and expected service line placement where available.
This summary provides a concise reference for revenue cycle, coding, and clinical teams seeking clarity on procedural scope and coding relationships for infratentorial/posterior fossa tumor excision under CPT code 61518.
Billing Code Overview
CPT code 61518 describes a surgical procedure in which a portion of the skull (craniectomy) is removed to excise a brain tumor located below the tentorium cerebelli or within the posterior fossa near the brain stem. This procedure is performed for tumors that are not meningiomas, cerebellopontine angle tumors, or midline tumors at the base of the skull.
Service type: Open intracranial tumor excision (infratentorial/posterior fossa craniectomy)
Typical site of service: Inpatient operating room within a hospital setting (neurosurgical service)
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient presents with progressive headaches, nausea, and new-onset left-sided weakness. Brain MRI shows a contrast-enhancing lesion in the cerebellar hemisphere of the posterior fossa with mass effect on the fourth ventricle and early obstructive hydrocephalus. Neurological exam demonstrates dysarthria and truncal ataxia. After multidisciplinary tumor board review, the neurosurgery team schedules a craniectomy with microsurgical excision of the infratentorial tumor below the tentorium cerebelli.
Preoperative workflow includes neurosurgical evaluation, informed consent, pre-op imaging review (contrast MRI and CT for surgical planning), anesthesiology clearance, and blood typing/crossmatch. Intraoperative workflow includes neuronavigation, microsurgical craniectomy, tumor resection, hemostasis, and dural closure. Postoperative care includes ICU or step-down monitoring for neurologic status, postoperative imaging (CT or MRI) to assess resection and hemorrhage, pain control, and early rehabilitation for deficits such as aphasia or ataxia. Discharge planning involves coordination with physical and speech therapy and follow-up with neurosurgery and oncology as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | When case involves markedly greater work than typical (extensive hemorrhage, prolonged dissection) and documentation supports increased complexity. |