Summary & Overview
CPT 61796: Targeted Radiosurgery for Single, Simple Cranial Lesion
CPT code 61796 designates stereotactic treatment using externally generated ionizing radiation to ablate a single, simple cranial lesion (typically <3.5 cm). This procedure is clinically important for treating solitary brain metastases, select primary brain tumors, and certain benign intracranial lesions where focused, noninvasive radiation is preferred over open surgery. Nationally, utilization of focused cranial radiosurgery affects interdisciplinary care pathways, facility resource planning, and payer coverage decisions because it concentrates high-cost, high-skill resources into outpatient and ambulatory settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the procedure and its clinical context, typical sites of service and service type, and what to expect from payer coverage and coding practice. The publication also highlights common billing modifiers and data elements where available. Where specific input data is missing, the text clearly notes that information is not available in the input.
This summary is intended for clinicians, coding professionals, and policy analysts who need a concise national-level briefing on the clinical purpose, billing context, and payer landscape for CPT code 61796.
Billing Code Overview
CPT code 61796 describes a procedure in which the provider uses externally generated ionizing radiation to destroy a single, simple cranial lesion in a targeted area of the brain. The designation simple lesion typically indicates a maximum lesion dimension of less than 3.5 cm.
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Service type: Stereotactic radiosurgery or focused external beam radiation therapy targeting a single intracranial lesion
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Typical site of service: Hospital outpatient department or ambulatory surgical center, depending on facility capabilities and care setting
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Clinical & Coding Specifications
Clinical Context
A typical patient is a 58-year-old with a solitary metastatic brain lesion measuring 2.2 cm in maximum diameter discovered on contrast MRI during oncologic surveillance. The patient has controlled systemic disease and neurologic symptoms limited to mild, focal headaches without major motor deficits. The multidisciplinary tumor board (neurosurgery, radiation oncology, and medical oncology) determines the lesion is appropriate for stereotactic radiosurgery (SRS) using a single session of externally generated ionizing radiation to ablate the target.
Workflow: The patient undergoes a preprocedure evaluation including history, neurologic exam, and contrast MRI to define target geometry. Immobilization is planned (frameless or frame-based), and a high-resolution stereotactic planning CT is fused with MRI. The radiation oncologist and medical physicist contour the target and critical structures and generate a plan to deliver a conformal dose to the lesion while sparing normal brain. On the day of service, the patient is positioned with immobilization, image guidance is used to verify target alignment, and a single-session radiosurgery treatment is delivered. Postprocedure monitoring occurs briefly in the radiation oncology clinic with outpatient follow-up imaging at 6–12 weeks and serial surveillance thereafter. Billing for the ablative radiosurgery of a single simple cranial lesion uses 61796 with applicable modifiers to reflect professional/technical components, bilateral or laterality, or unusual circumstances.
Coding Specifications
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