CPT 62005 Elevation Depressed Skull Fracture Reimbursement | OpenPayer

Summary & Overview

CPT 62005: Elevation of Depressed Skull Fracture

CPT code 62005 designates the open surgical elevation of a depressed skull fracture for compound or comminuted injuries that do not extend to the dura. This procedure restores skull contour and addresses cosmetic and structural defects following trauma. Nationally, this code is relevant to trauma centers, neurosurgical services, and acute hospital surgical departments where cranial fracture management is provided.

Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, and payer coverage considerations. The publication also outlines benchmarks and common billing modifiers used with this service, policy variations that commonly affect reimbursement and prior authorization, and coding relationships to related neurosurgical procedures.

This summary is intended to inform billing, compliance, and clinical staff about the coding definition, expected clinical setting, and payer landscape for CPT code 62005. Data not available in the input is noted where applicable in detailed sections.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare62005CPTneurosurgerycranial-fracturesurgical-repairoperating-roomtrauma-surgerybilling-and-coding

Billing Code Overview

CPT code 62005 describes a surgical procedure to correct a depressed skull fracture by incising the scalp and elevating the inwardly displaced portion of skull bone. The service applies to compound or comminuted fractures in which the skull bone is broken into fragments or the skin is breached, provided the fracture does not reach the dura mater. The procedure restores the normal contour of the skull and addresses the visible depression caused by the fracture.

Service type: Surgical repair of depressed skull fracture (open elevation and restoration of skull contour)
Typical site of service: Operating room or acute hospital surgical setting

Clinical & Coding Specifications

Clinical Context

A 28-year-old male is brought to the emergency department after a motorcycle collision with a visible open scalp wound and a palpable depression of the parietal skull over the left hemisphere. He is awake and hemodynamically stable but reports localized pain and a cosmetic deformity. Noncontrast head CT demonstrates a compound depressed skull fracture without dural penetration and no intracranial hemorrhage. The neurosurgery team evaluates the patient and schedules operative management: under general anesthesia the scalp is incised, the fracture fragments are elevated and contoured to restore normal skull convexity, contaminated bone fragments are debrided, and the wound is irrigated and closed. Postoperatively the patient is observed in a monitored bed for neurologic change, receives antibiotics for a compound fracture, and returns for outpatient wound and neurologic follow-up.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — Standard reporting	Use for routine reporting when no special circumstances apply
`11`	Office or other outpatient service as the normal component of the physician’s work	Use when this is the surgeon’s standard level of service (facility billing may also apply)

CPT 62143: Replacement of Bone Flap or Prosthetic Skull Plate

CPT-62145-CRANIAL-RECONSTRUCTION-WITH-BRAIN-REPAIR

CPT 62145: Cranial Reconstruction with Brain Tissue Repair

CPT-62141-CRANIAL-BONE-REMOVAL-AND-SKULL-DEFECT-REPAIR-GREATER-THAN-5CM

CPT 62141: Cranial Bone Removal and Skull Defect Repair >5 cm

CPT-62148-CRANIOPLASTY-RETRIEVAL-AUTOLOGOUS-CRANIAL-BONE-GRAFT

CPT 62148: Cranioplasty Using Previously Stored Autologous Cranial Bone Graft

CPT-62115-CRANIAL-SKULL-REDUCTION-CRANIOMEGALY

CPT 62115: Reduction of Enlarged Skull (Craniomegaly)

CPT-62140-CRANIAL-BONE-REMOVAL-AND-SKULL-DEFECT-REPAIR-UP-TO-5CM

CPT 62140: Cranial Bone Removal and Skull Defect Repair, Up to 5 cm

CPT-62142-CRANIAL-IMPLANT-BONE-FLAP-REMOVAL

CPT 62142: Removal of Bone Flap or Prosthetic Skull Plate

CPT-62000-DEPRESSED-SKULL-FRACTURE-ELEVATION-BURR-HOLE

CPT 62000: Elevation of Closed Depressed Skull Fracture via Burr Hole

CPT-62147-CRANIOPLASTY-AUTOLOGOUS-BONE-GRAFT-LARGE-CRANIAL-DEFECT

CPT 62147: Cranioplasty with Autologous Bone Graft for Large Cranial Defect

CPT-62100-CRANIAL-DURAL-REPAIR-CSF-LEAK

CPT 62100: Cranial Dural Repair for Cerebrospinal Fluid Leak

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Taxonomy Code	Specialty	Notes
2084P0800X	Neurosurgery	Primary specialty performing depressed skull elevation and cranial fracture management
2080S0102X	General Surgery	May perform in trauma centers when neurosurgery not available, depending on scope and complexity
207RC0000X	Emergency Medicine	Performs initial evaluation and stabilization; may assist in triage and initial wound care
207RP0000X	Family Medicine	Uncommonly involved surgically; may provide follow-up wound care in outpatient setting

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S02.61XA`	Depressed fracture of skull, initial encounter	Primary diagnosis indicating a depressed skull fracture appropriate for elevation without dural penetration
`S02.611A`	Displaced depressed fracture of skull, initial encounter	Specifies displacement when fragments are inward — indicates need for elevation and contouring
`S02.69XA`	Other fracture of skull, initial encounter	Used when fracture pattern is complex or comminuted but not otherwise classified
`S01.01XA`	Open bite of scalp without foreign body, initial encounter	Reflects compound nature with scalp laceration requiring debridement and wound repair alongside elevation
`S06.0X0A`	Concussion without loss of consciousness, initial encounter	Common associated intracranial injury that may accompany skull fractures and affect management

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61618`	Craniotomy or craniectomy for excision of lesion or repair of traumatic injury; with elevation of depressed skull fracture when dura is opened	Performed when dural breach or intracranial pathology requires craniotomy rather than a closed elevation — a more extensive adjacent procedure
`12032`	Repair, intermediate, wounds of scalp, arms, and/or legs; 2.6 cm to 7.5 cm	May be billed for layered scalp wound repair performed concurrently if separate from fracture elevation technique and tissue repair is required
`10160`	Puncture aspiration of abscess; simple or single	Used if postoperative or preoperative localized scalp abscess requires drainage in the same episode
`99223`	Initial hospital care, typically 70 minutes or more	Used for the admitting evaluation and management of a complex trauma patient undergoing operative repair of a depressed skull fracture
`61790`	Craniectomy, open, for traumatic brain injury; decompression	Performed in the same clinical workflow if the patient develops or presents with elevated intracranial pressure necessitating decompressive craniectomy

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