CPT 61564 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 61564: Cranial Bone Tumor Resection with Optic Nerve Decompression

CPT code 61564 represents a neurosurgical procedure for removal of cranial bone affected by a tumor with concurrent decompression of the optic nerve through removal of the optic canal roof. This code captures a specialized cranial surgery aimed at relieving optic nerve compression and addressing bony tumor involvement, which has implications for patient vision outcomes and resource use in tertiary surgical centers. The procedure is typically performed in a hospital operating room or inpatient surgical suite and is relevant to neurosurgery and ophthalmic-neurosurgical teams.

Key payers addressed in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical context for use of 61564, typical settings where the service is provided, and what to expect in coding and billing workflows at a high level. The publication also provides benchmarks and policy context where available, highlights common modifiers used with this service (input provided), and situates the code within related surgical service lines. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare61564CPTneurosurgeryoptic nerve decompressioncranial bone tumorsurgical procedurehospital inpatientoperative coding

Billing Code Overview

CPT code 61564 describes a neurosurgical procedure in which the surgeon makes an incision in the scalp over a cranial bone tumor, removes the involved bone, and decompresses the optic nerve by removing the roof of the optic nerve canal. This procedure addresses mass effect on the optic apparatus caused by lesions of the cranial vault adjacent to the optic nerve.

Service type: Neurosurgical cranial bone tumor resection with optic nerve decompression
Typical site of service: Hospital operating room or inpatient surgical suite

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient presents with progressive visual field loss and headaches. Neuroimaging (MRI and CT) demonstrates a cranial bone tumor involving the sphenoid bone with compression of the optic canal and impingement on the optic nerve. The neurosurgical team schedules an open cranial approach: a scalp incision over the cranial bone tumor, resection of involved cranial bone (craniectomy or bone flap removal as indicated), and decompression of the optic nerve by removing the roof of the optic nerve canal. The clinical workflow includes preoperative neuroimaging and ophthalmologic evaluation, informed consent, general endotracheal anesthesia, intraoperative neuro-monitoring as indicated, scalp incision and exposure, bone removal and tumor resection, optic canal decompression, hemostasis, dural management if required, closure, postoperative recovery in PACU or ICU for neurologic monitoring, and scheduled postoperative imaging and ophthalmology follow-up to assess visual recovery and detect complications such as cerebrospinal fluid leak, infection, or hematoma.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work required is substantially greater than typical for `61564` (documentation must support).

CPT 61510: Craniectomy/Craniotomy for Supratentorial Brain Tumor

CPT-61316-CRANIAL-BONE-GRAFT-POCKETING-TEMPORARY-ABDOMINAL-STORAGE

CPT 61316: Temporary Subcutaneous Cranial Bone Graft Pocketing

CPT-61576-TRANSORAL-SKULL-BASE-BRAINSTEM-UPPER-SPINAL-CORD-SURGERY

CPT 61576: Transoral Skull Base, Brain Stem, Upper Spinal Cord Surgery

CPT-61535-INTRACRANIAL-ELECTRODE-ARRAY-REMOVAL

CPT 61535: Removal of Intracranial Electrode Array

CPT-61537-TEMPORAL-LOBE-RESECTION-FOR-EPILEPSY

CPT 61537: Temporal Lobe Resection for Epilepsy

CPT-61531-SUBDURAL-ELECTRODE-PLACEMENT-FOR-SEIZURE-MONITORING

CPT 61531: Subdural Electrode Placement for Seizure Monitoring

CPT-61312-SUPRATENTORIAL-HEMATOMA-EVACUATION-CRANIOTOMY

CPT 61312: Supratentorial Intracranial Hematoma Evacuation

CPT-61320-INTRACRANIAL-ABSCESS-DRAINAGE-SUPRATENTORIAL

CPT 61320: Supratentorial Intracranial Abscess Drainage

CPT-61545-CRANIOTOMY-CRANIOPHARYNGIOMA-RESECTION-SELLAR-SUPRASELLAR

CPT 61545: Craniotomy for Craniopharyngioma Resection

CPT-61516-SUPRATENTORIAL-CYST-EXCISION-CRANIOTOMY

CPT 61516: Supratentorial Cyst Excision with Craniotomy

Showing 1–10 of 62

52

Taxonomy Code	Specialty	Notes
`207RH0000X`	Neurological Surgery	Primary specialty performing cranial bone tumor resection with optic canal decompression.
`2080P0222X`	Ophthalmology	Preoperative and postoperative visual assessment and ongoing optic nerve monitoring.
`2086S0122X`	Otolaryngology	May be involved for skull base approaches or combined endoscopic approaches.
`363L00000X`	Neurocritical Care	Postoperative neurologic monitoring and ICU management when required.
`334P00000X`	Anesthesiology	Provides perioperative anesthesia care for craniotomy/craniectomy procedures.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C71.9`	Malignant neoplasm of brain, unspecified	Primary intracranial neoplasm that may invade cranial bone requiring resection and optic nerve decompression.
`D16.9`	Benign neoplasm of bone, unspecified	Benign cranial bone tumors (e.g., osteoma, fibrous dysplasia) that may compress optic canal.
`D32.0`	Benign neoplasm of cerebral meninges (meningioma)	Meningiomas adjacent to the optic canal often require bone removal and optic canal decompression.
`H47.013`	Compression of optic nerve, right eye	Direct clinical indication for optic nerve decompression when caused by extrinsic mass.
`H47.014`	Compression of optic nerve, left eye	Same clinical relevance for contralateral involvement.
`C41.9`	Malignant neoplasm of bone and articular cartilage, unspecified	Primary bone malignancy involving cranial bones that may necessitate resection.
`S02.0`	Fracture of skull	Posttraumatic depressed skull or bone fragments compressing optic canal may require bone removal and decompression.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61564`	Craniectomy or craniotomy for cranial bone tumor; resection of bone and decompression of optic nerve canal roof	Primary procedure: removal of involved cranial bone and optic canal decompression.
`61582`	Excision of meningioma involving the orbit and optic canal, craniotomy with orbital roof removal (example code for orbital/optic canal tumor resection)	May be performed when tumor extends into orbit or requires orbital roof work in addition to optic canal decompression.
`62165`	Transcranial decompression of optic nerve; with unroofing of the optic canal	Closely related decompression code; sometimes used when optic canal decompression is the primary focus without larger cranial bone tumor resection.
`61619`	Excision or destruction of cranial tumor, extradural; first lesion	May be used when the lesion is extradural and primary procedure focuses on tumor excision of cranial bone rather than intradural pathology.
`69990`	Microsurgical techniques, requiring use of operating microscope	Often reported when microscopic techniques are integral to resection and optic nerve decompression.
`99100`	Anesthesia for patient of extreme age, under 1 or over 70 years, requiring more anesthesia time and skill	Potential anesthesia add-on when applicable by patient age and payor rules.

OpenPayer