Summary & Overview
CPT 61591: Middle Cranial Fossa Infratemporal Preauricular Approach
CPT code 61591 represents a complex neurosurgical approach to the middle cranial fossa using an infratemporal, preauricular (transparotid) corridor to expose skull-base lesions or defects. The technique is used to access lesions involving the petrous apex, auditory canal, sigmoid sinus, or adjacent skull-base structures and can include ancillary procedures such as mastoidectomy or sigmoid sinus resection. Nationally, this code captures high-complexity skull-base surgery performed primarily at tertiary hospitals and specialized surgical centers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, the typical settings where it is performed, and the practical billing considerations tied to a high-complexity cranial base approach. The publication outlines benchmarks for utilization and payment trends, identifies common documentation and coding touchpoints relevant to surgical teams and billing staff, and summarizes policy updates that affect hospital-based surgical reimbursement for complex skull-base procedures.
This summary is intended for national audiences including neurosurgeons, otolaryngologists, hospital administrators, and revenue cycle professionals who need a focused reference on procedural intent, setting, and payer coverage landscape for CPT code 61591.
Billing Code Overview
CPT code 61591 describes a surgical approach to the middle cranial fossa via an infratemporal preauricular (transparotid) route to expose a lesion or defect at the skull base. The procedure may include mastoidectomy, resection of the sigmoid sinus, and/or decompression or mobilization of the auditory canal or petrous carotid artery depending on lesion location and size.
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Service type: Skull base surgical approach to middle cranial fossa; cranial base neurosurgical procedure
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Typical site of service: Hospital operating room; tertiary care surgical center; inpatient or outpatient surgical facility depending on complexity and need for postoperative monitoring
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with progressive unilateral cranial neuropathies and imaging demonstrating a lesion involving the petrous apex and middle cranial fossa consistent with a benign skull base tumor. Neurosurgery and otolaryngology coordinate care. The patient is admitted to an acute care hospital and undergoes preoperative evaluation including CT and MRI of the temporal bone and skull base, audiometry, and vascular imaging to delineate relationships to the petrous carotid and sigmoid sinus. Intraoperative monitoring (facial nerve and auditory brainstem responses) is used. The surgeon performs an infratemporal preauricular (transparotid) approach to the middle cranial fossa with exposure of the petrous bone and tumor resection; this may include a mastoidectomy, limited sigmoid sinus mobilization, and decompression of the auditory canal. Postoperatively the patient goes to a neurosurgical step-down or intensive care unit, receives serial neurologic exams, pain control, and wound care, and has follow-up imaging to assess residual lesion and vascular status. Typical site of service is an inpatient operating room in an acute care hospital. Service type is an operative skull base approach to access lesions of the middle cranial fossa via an infratemporal preauricular (transparotid) route.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
62 | Two surgeons | Use when two surgeons of different specialties perform distinct portions of the procedure concurrently (eg, neurosurgeon and otolaryngologist). |