Summary & Overview
CPT 61797: Add-on Stereotactic Radiosurgery for Additional Cranial Lesion
CPT code 61797 designates an add-on stereotactic radiosurgery (SRS) procedure for destruction of an additional simple intracranial lesion during the same treatment session following the primary cranial lesion. It matters nationally because SRS is a widely used, high-cost, high-complexity treatment modality for brain lesions; add-on codes like 61797 affect session-level billing, case costing, and payer coverage policies for multi-target treatments.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The paper outlines what facilities and clinicians should expect in payer coverage approaches and how this add-on code interacts with primary SRS codes in episode-level reimbursement.
Readers will learn the clinical context of the code, typical sites of service for use, common payer considerations, and where to look for benchmarks and policy updates. The summary highlights that 61797 is tied to single-session treatment of multiple simple lesions and that billing will typically occur alongside a primary SRS CPT code. Data not provided in the input for specific payer edits, payment rates, and associated diagnosis coding is noted as unavailable; where available, readers will find guidance on documentation requirements and coding relationships to support accurate claims submission.
Billing Code Overview
CPT code 61797 is an add-on stereotactic radiosurgery (SRS) procedure used when a provider applies externally generated ionizing radiation to destroy an additional simple intracranial target area during the same session after treatment of a first cranial lesion. The descriptor indicates the targeted lesion is simple (commonly a maximum dimension under 3.5 cm).
Service type: Stereotactic radiosurgery (add-on lesion treatment)
Typical site of service: Hospital outpatient department or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with one or more small intracranial metastatic lesions or other focal cranial lesions diagnosed by MRI. The patient is evaluated in a multidisciplinary neuro-oncology or radiosurgery clinic and is scheduled for a stereotactic radiosurgery session using a Gamma Knife, linear accelerator (LINAC) with stereotactic capability, or CyberKnife. During the same session a first target lesion is treated; 61797 is reported when the provider directs externally generated ionizing radiation to destroy each additional simple cranial target (generally < 3.5 cm maximum dimension) after the first lesion has been treated. The workflow includes pre-procedure imaging and planning (high-resolution MRI +/- CT), patient immobilization and stereotactic localization, dosimetry planning, delivery of focused radiation to the first lesion, then sequential treatment delivery to each additional qualifying lesion during the same session. Typical site of service is an outpatient hospital radiation oncology department, freestanding radiation therapy center, or ambulatory surgery center with dedicated radiosurgery capability. Typical clinical documentation includes lesion size/location, imaging-based target delineation, treatment plan parameters, number of targets treated, total dose per target, device used, and operative/radiation report noting each additional target treated under 61797.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 |