Summary & Overview
CPT 61791: Percutaneous Stereotactic Lesioning of Trigeminal Medullary Tract
CPT code 61791 specifies a percutaneous stereotactic procedure that uses a nerve-destroying agent to create a lesion in the trigeminal medullary tract of the brainstem. This neurosurgical technique is used for precise targeting of small brainstem structures and matters nationally because it represents a specialized, high-acuity intervention with implications for coverage policies, facility resource use, and coding consistency across payers. Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and procedural setting, expected payer coverage patterns, benchmarks where available, and notes on documentation and coding considerations relevant to authorization and claims review. The content highlights how this code fits into stereotactic neurosurgical service lines, typical sites of service (hospital inpatient, hospital outpatient, and ambulatory surgical centers), and the kinds of clinical scenarios that may prompt use of this service. Data not available in the input is noted where applicable. This summary is intended for billing managers, coding professionals, and policy analysts who need a national-level briefing on CPT code 61791 and its operational and policy context.
Billing Code Overview
CPT code 61791 describes a percutaneous stereotactic procedure in which a nerve-destroying agent is applied to create a lesion in the trigeminal medullary tract of the brainstem. The technique uses a three-dimensional coordinate system to precisely locate small targets within the brain.
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Service type: Percutaneous stereotactic lesioning of the trigeminal medullary tract using a neurolytic agent
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Typical site of service: Inpatient or outpatient hospital setting or ambulatory surgical center where stereotactic neurosurgical procedures are performed
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with debilitating, medication-refractory trigeminal neuralgia presents for percutaneous stereotactic trigeminal tractotomy using a neurolytic agent. The patient has a longstanding history of lancinating facial pain localized to the V2 distribution, with prior trials of anticonvulsants and microvascular decompression either unsuccessful or contraindicated. Pre-procedure workflow includes neurosurgical evaluation, informed consent, preoperative imaging with MRI to exclude alternative pathology, stereotactic planning using three-dimensional coordinates, and anesthesia assessment for monitored anesthesia care or general anesthesia depending on patient factors. In the interventional suite, a stereotactic frame or frameless navigation is applied, a percutaneous approach is used to reach the trigeminal medullary tract, and a neurolytic lesion is created. Post-procedure care includes neurologic monitoring, pain assessment, wound care for the percutaneous entry site, and outpatient follow-up for pain control and potential sensory deficits. Typical sites of service are an ambulatory surgery center or hospital operating room. Service type is a percutaneous stereotactic neuroablative procedure on the trigeminal medullary tract.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/technical component is split and the facility bills the technical portion. |