Summary & Overview
CPT 61558: Cranial Vault Remodeling for Craniosynostosis
CPT code 61558 represents cranial vault remodeling surgery performed to correct craniosynostosis by removing and reshaping portions of the cranium. This procedure is clinically significant because timely surgical correction can prevent intracranial pressure elevation, support normal brain development, and correct skull deformity. Nationally, craniosynostosis repair is a specialized pediatric neurosurgical and craniofacial service with implications for hospital resource use, surgical staffing, and post-operative care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and typical sites of service, comparisons of payer coverage approaches where available, common modifier usage, and related policy and coding considerations. The publication summarizes benchmarks for utilization and reimbursement patterns when available and highlights policy updates that affect authorization, bundling, and site-of-service determinations.
This report provides clinicians, billing professionals, and policy stakeholders with practical context about CPT code 61558, including what the code denotes, typical care settings, and the topics to consider when planning, coding, or reviewing claims for cranial vault remodeling for craniosynostosis.
Billing Code Overview
CPT code 61558 describes a cranial vault remodeling procedure performed to correct craniosynostosis, a condition in which one or more cranial sutures fuse prematurely. In this operation the surgeon incises the skull, removes portions of the cranium as needed, and reshapes or remodels the skull to restore a more anatomically appropriate contour and allow normal brain and head growth.
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Service type: Surgical cranial vault remodeling for craniosynostosis
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Typical site of service: Inpatient hospital or ambulatory surgery center where neurosurgical or craniofacial procedures are performed
Clinical & Coding Specifications
Clinical Context
A 6-month-old infant presents with abnormal skull shape and scalp ridge consistent with sagittal craniosynostosis. Imaging (CT with 3D reconstruction) confirms premature fusion of the sagittal suture with compensatory frontal and occipital bossing and evidence of increased intracranial pressure. The craniofacial surgery team schedules a cranial vault remodeling with removal and reshaping of calvarial bone to restore normal skull contour and relieve intracranial pressure.
Preoperative workflow includes multidisciplinary evaluation (pediatric neurosurgery, craniofacial/plastic surgery, anesthesiology), baseline labs, and neuroimaging. Intraoperative details include bicoronal incision, elevation of scalp flaps, craniectomy/craniotomy with removal of fused suture segments, remodeling of bone segments, and fixation with resorbable plates/screws as indicated. Postoperative care includes pediatric intensive care monitoring, pain management, wound care, and outpatient follow-up for neurodevelopmental assessment and imaging as needed.
Typical site of service: hospital operating room with postoperative inpatient stay. Service type: major reconstructive craniofacial surgery for craniosynostosis. Typical patient: pediatric patient, often under 12 months, undergoing open cranial vault remodeling for fused cranial sutures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Standard coding (no modifier) |