Summary & Overview
CPT 61735: Cingulotomy, Psychosurgical Procedure
CPT code 61735 represents cingulotomy, a psychosurgical intervention that severs interconnecting neuronal pathways implicated in emotional regulation and certain autonomic functions. Nationally, this code is significant because it designates a targeted neurosurgical option for severe, treatment-refractory psychiatric conditions when conventional therapies have failed or when no organic pathology can be demonstrated. The procedure is specialized and infrequent, with implications for coverage determinations, care pathways, and facility resource planning.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for cingulotomy, typical sites of service, and how CPT code 61735 is positioned in payer coverage discussions. The publication summarizes common modifiers associated with surgical procedures and highlights areas where policy updates or national coverage determinations influence access and billing. It also outlines the type of benchmarks and policy topics addressed, including utilization patterns, prior authorization considerations, and alignment with Medicare National Coverage Determinations.
This summary is intended to inform clinicians, coding professionals, and policy analysts about the clinical meaning and payer context of CPT code 61735, and to indicate the topics covered in the full publication.
Billing Code Overview
CPT code 61735 describes a cingulotomy, a psychosurgical procedure intended to interrupt interconnecting neuronal pathways involved in emotion regulation and certain autonomic functions. The procedure is used to modify or alter disturbances of behavior, thought content, or mood that have not responded to conventional therapies or for which no demonstrable organic pathological cause is found by established methods.
Service Type: Psychosurgical procedure (cingulotomy)
Typical Site of Service: Inpatient or outpatient surgical setting, performed in a neurosurgical operating room or specialized surgical suite
Data not available in the input for associated taxonomies, specific ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient with treatment-refractory major depressive disorder and severe obsessive-compulsive disorder is evaluated by a multidisciplinary team after multiple trials of medications, psychotherapy, and electroconvulsive therapy have failed. The patient experiences persistent, severe functional impairment, suicidality risk, or incapacitating compulsions. After psychiatric, neuropsychological, and neurosurgical assessments, informed consent is obtained and the team schedules a bilateral cingulotomy.
The clinical workflow includes preoperative psychiatric stabilization, neuroimaging (MRI) to plan lesion targets in the anterior cingulate cortex, anesthesia evaluation, and intraoperative neuronavigation. The procedure is performed in an operating room with neurosurgical staff and monitoring. Postoperative care involves inpatient monitoring for neurologic and psychiatric status, pain control, and early postoperative neuropsychological assessment. Follow-up includes ongoing psychiatric care to assess mood, behavior, and functional outcomes, and documentation of failed prior therapies in the medical record to support medical necessity for this psychosurgical intervention.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Primary procedure | When this cingulotomy is the main procedure performed during the operative session. |