Find policies, billing codes, payers, states, and providers

CPT 61590: Infratemporal Preauricular Approach to Middle Cranial Fossa

CPT code 61590 identifies an infratemporal preauricular (transparotid) approach to the middle cranial fossa for exposure of lesions or defects at the skull base. The code covers open skull-base neurosurgical access techniques and is relevant for cranial neurosurgery practices, hospital surgical departments, and payer coverage policies involving complex skull-base procedures. Nationally, accurate coding of skull-base approaches affects facility and professional reimbursement, utilization tracking, and quality measurement for high-complexity neurosurgical care.

Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for when CPT code 61590 is used, the typical service setting, and how this code fits into broader billing workflows for skull-base surgery. The publication also covers benchmark elements commonly reviewed by payers and providers, such as service definitions, typical sites of service, and related coding considerations. Data not provided in the input (for example, specific ICD-10 pairings or associated taxonomies) is noted as unavailable.

Customize your policy alerts

Sign up for cpt 61590 policy alerts

Get alerted when payer policies referencing 61590 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

CPT code 61590 describes a surgical approach to the middle cranial fossa using an infratemporal preauricular (transparotid) approach to expose a lesion or defect at the base of the skull. The procedure may be combined with a transtemporal approach when lesions extend posteriorly into the temporal bone.

Service type: Skull base neurosurgical approach / open cranial surgery

Typical site of service: Operating room (inpatient or outpatient surgical setting depending on lesion complexity and patient needs)

Data not available in the input for Associated Taxonomies, ICD-10 Diagnoses, and Related Codes.

Explore openpayer tools

View all tools

Find policies, billing codes, payers, states, and providers

CPT 61590: Infratemporal Preauricular Approach to Middle Cranial Fossa

Customize your policy alerts

Sign up for cpt 61590 policy alerts

Get alerted when payer policies referencing 61590 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

Service type: Skull base neurosurgical approach / open cranial surgery

Typical site of service: Operating room (inpatient or outpatient surgical setting depending on lesion complexity and patient needs)

Data not available in the input for Associated Taxonomies, ICD-10 Diagnoses, and Related Codes.

Clinical & Coding Specifications

Clinical Context

A 54-year-old patient presents with progressive hearing loss and intermittent cranial neuropathic pain. Imaging (MRI and CT) demonstrates a petroclival meningioma centered at the middle cranial fossa with extension toward the temporal bone and involvement of structures near the internal auditory canal. The neurosurgical team schedules a skull base resection using an infratemporal preauricular (transparotid) approach to expose and resect the lesion at the base of skull. The workflow includes preoperative multidisciplinary planning with neurosurgery and otolaryngology, preoperative neuroimaging review, informed consent discussing potential facial nerve and hearing risks, intraoperative neurophysiologic monitoring, general endotracheal anesthesia, possible combined transtemporal exposure if the tumor extends posteriorly, and postoperative ICU or step-down monitoring for cranial nerve function, wound care, and imaging surveillance.

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two qualified surgeons work together as primary surgeons for complex skull base exposure or resection.
`80`	Assistant surgeon	Use when a surgical assistant participates in the procedure (assistant surgeon).
`62`	Two surgeons	Use when two qualified surgeons work together as primary surgeons for complex skull base exposure or resection.
`22`	Increased procedural services	Use when operative difficulty or extended time significantly increases work beyond usual for the procedure.
`52`	Reduced services	Use when the procedure is partially performed or terminated early for clinical reasons.
`53`	Discontinued procedure	Use when the procedure is stopped prior to completion due to extenuating circumstances.
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from technical facility charges where applicable.
`73`	Discontinued outpatient hospital/ambulatory surgery prior to anesthesia administration	Use if the outpatient case is canceled after patient preparation but before anesthesia.
`78`	Return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period	Use for reoperation for complication (e.g., hemorrhage) related to the initial skull base approach.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated operation is performed during the global period.
`76`	Repeat procedure by same physician	Use if the exact procedure is repeated subsequent to the initial service.
`58`	Staged or related procedure or service by the same physician during the postoperative period	Use when planned staged skull base procedures are performed.
`RT`	Right side	Use to indicate the procedure was performed on the right side when laterality is relevant.
`LT`	Left side	Use to indicate the procedure was performed on the left side when laterality is relevant.

Taxonomy Code	Specialty	Notes
207RH0000X	Neurological Surgery	Primary specialty performing skull base and middle cranial fossa approaches.
207L00000X	Otolaryngology	Skull base and lateral skull base approaches in partnership with neurosurgery.
2080P0207X	Head and Neck Surgical Oncology	May be involved for tumors with complex cranial base involvement.
2084N0400X	Neurocritical Care	Postoperative management of neurosurgical patients in ICU settings.
207VP0000X	Vascular Neurology	Consultation when vascular involvement or complex neurovascular reconstruction is anticipated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C71.4`	Brain stem and other parts of brain	Primary skull base or adjacent intracranial neoplasms requiring middle cranial fossa access when tumor location involves temporal/brainstem-adjacent structures.
`C79.31`	Secondary malignant neoplasm of brain	Metastatic lesions to the middle cranial fossa requiring surgical access for resection or decompression.
`D32.0`	Benign neoplasm of cerebral meninges	Meningiomas of the middle cranial fossa/petroclival region commonly approached via infratemporal preauricular route.
`G51.0`	Bell's palsy	Not an indication for this approach but included when facial nerve decompression is performed for skull base lesions causing neuropathy.
`H60.5`	Otitis externa, unspecified	Included when combined otologic procedures or transtemporal approaches address temporal bone extension of skull base lesions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61590`	Craniectomy or craniotomy, middle cranial fossa; infratemporal (transparotid) preauricular approach	Primary code describing the infratemporal preauricular exposure to the middle cranial fossa for skull base lesion access.
`61610`	Craniectomy or craniotomy, posterior cranial fossa; foramen magnum or suboccipital approach	Related when tumor extends posteriorly requiring combined transtemporal or posterior fossa exposure.
`69990`	Unlisted procedure, head or neck	Use for unusual adjunctive procedures or devices not described by a specific CPT when performed with skull base surgery.
`61876`	Excision or drainage of an intracranial lesion; cortical or subcortical (supratentorial)	May be performed for lesion resection components depending on tumor location and extent.
`61595`	Craniectomy or craniotomy; lateral skull base approach (e.g., middle fossa craniotomy)	Alternative or complementary middle fossa/lateral skull base approach codes depending on the exact exposure and work performed.

CPT 61591: Middle Cranial Fossa Infratemporal Preauricular Approach

CPT-61592-ORBITOCRANIAL-MIDDLE-CRANIAL-FOSSA-APPROACH

CPT 61592: Orbitocranial Approach to Middle Cranial Fossa

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`62`	Two surgeons	Use when two qualified surgeons work together as primary surgeons for complex skull base exposure or resection.
`80`	Assistant surgeon	Use when a surgical assistant participates in the procedure (assistant surgeon).
`62`	Two surgeons	Use when two qualified surgeons work together as primary surgeons for complex skull base exposure or resection.
`22`	Increased procedural services	Use when operative difficulty or extended time significantly increases work beyond usual for the procedure.
`52`	Reduced services	Use when the procedure is partially performed or terminated early for clinical reasons.
`53`	Discontinued procedure	Use when the procedure is stopped prior to completion due to extenuating circumstances.
`26`	Professional component	Use when reporting only the surgeon’s professional component separate from technical facility charges where applicable.
`73`	Discontinued outpatient hospital/ambulatory surgery prior to anesthesia administration	Use if the outpatient case is canceled after patient preparation but before anesthesia.
`78`	Return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period	Use for reoperation for complication (e.g., hemorrhage) related to the initial skull base approach.
`79`	Unrelated procedure or service by the same physician during the postoperative period	Use when an unrelated operation is performed during the global period.
`76`	Repeat procedure by same physician	Use if the exact procedure is repeated subsequent to the initial service.
`58`	Staged or related procedure or service by the same physician during the postoperative period	Use when planned staged skull base procedures are performed.
`RT`	Right side	Use to indicate the procedure was performed on the right side when laterality is relevant.
`LT`	Left side	Use to indicate the procedure was performed on the left side when laterality is relevant.

Taxonomy Code	Specialty	Notes
207RH0000X	Neurological Surgery	Primary specialty performing skull base and middle cranial fossa approaches.
207L00000X	Otolaryngology	Skull base and lateral skull base approaches in partnership with neurosurgery.
2080P0207X	Head and Neck Surgical Oncology	May be involved for tumors with complex cranial base involvement.
2084N0400X	Neurocritical Care	Postoperative management of neurosurgical patients in ICU settings.
207VP0000X	Vascular Neurology	Consultation when vascular involvement or complex neurovascular reconstruction is anticipated.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C71.4`	Brain stem and other parts of brain	Primary skull base or adjacent intracranial neoplasms requiring middle cranial fossa access when tumor location involves temporal/brainstem-adjacent structures.
`C79.31`	Secondary malignant neoplasm of brain	Metastatic lesions to the middle cranial fossa requiring surgical access for resection or decompression.
`D32.0`	Benign neoplasm of cerebral meninges	Meningiomas of the middle cranial fossa/petroclival region commonly approached via infratemporal preauricular route.
`G51.0`	Bell's palsy	Not an indication for this approach but included when facial nerve decompression is performed for skull base lesions causing neuropathy.
`H60.5`	Otitis externa, unspecified	Included when combined otologic procedures or transtemporal approaches address temporal bone extension of skull base lesions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61590`	Craniectomy or craniotomy, middle cranial fossa; infratemporal (transparotid) preauricular approach	Primary code describing the infratemporal preauricular exposure to the middle cranial fossa for skull base lesion access.
`61610`	Craniectomy or craniotomy, posterior cranial fossa; foramen magnum or suboccipital approach	Related when tumor extends posteriorly requiring combined transtemporal or posterior fossa exposure.
`69990`	Unlisted procedure, head or neck	Use for unusual adjunctive procedures or devices not described by a specific CPT when performed with skull base surgery.
`61876`	Excision or drainage of an intracranial lesion; cortical or subcortical (supratentorial)	May be performed for lesion resection components depending on tumor location and extent.
`61595`	Craniectomy or craniotomy; lateral skull base approach (e.g., middle fossa craniotomy)	Alternative or complementary middle fossa/lateral skull base approach codes depending on the exact exposure and work performed.

CPT 61591: Middle Cranial Fossa Infratemporal Preauricular Approach

CPT-61592-ORBITOCRANIAL-MIDDLE-CRANIAL-FOSSA-APPROACH

CPT 61592: Orbitocranial Approach to Middle Cranial Fossa

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.