CPT 62117 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 62117: Cranial Reconstruction for Craniomegaly

CPT code 62117 denotes cranial reconstructive surgery to remove or reduce portions of skull bone and reshape an enlarged (craniomegalic) skull, with optional bone graft repair. Nationally, this procedure is relevant for congenital and acquired cranial deformities and for post-traumatic or post-surgical reconstruction. It is typically performed in hospital operating rooms or ambulatory surgery centers by neurosurgeons or craniofacial surgeons and has implications for surgical quality, resource utilization, and payer coverage policies.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise benchmarking overview of how payers handle coverage and coding for cranial contouring procedures, highlights clinical context for appropriate use, and summarizes common billing considerations. Readers will find: a clear description of the clinical service and typical sites of care; summary guidance on common modifiers and billing practice (listed separately); and a national perspective on reimbursement patterns and policy considerations where available. Data not available in the input is identified explicitly. This resource is intended to inform coding accuracy, billing workflows, and payer discussions for providers and administrators managing cranial reconstructive procedures.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare62117CPTcranial reconstructionneurosurgeryskull contouringbone graftambulatory surgeryhospital services

Billing Code Overview

CPT code 62117 describes a surgical procedure to remove or reduce portions of the skull bone and recontour an enlarged (craniomegalic) skull. The procedure may include repair of the resulting defect using a bone graft when indicated.

Service type: Cranial reconstructive surgery / skull contouring with possible bone grafting

Typical site of service: Hospital operating room or ambulatory surgery center, performed by neurosurgery or craniofacial surgery teams.

Clinical & Coding Specifications

Clinical Context

A 6-month-old infant with sagittal craniosynostosis presents with an elongated, enlarged skull and evidence of increased intracranial pressure (progressive head circumference crossing percentiles, tense fontanelle, developmental delay). After multidisciplinary evaluation by pediatric neurosurgery and craniofacial/plastic surgery, corrective cranial vault remodeling is scheduled. In the operating room under general anesthesia, the surgical team performs a cranial vault remodeling procedure to remove and reshape portions of the calvarium to correct craniomegaly and relieve intracranial pressure; bone segments may be reshaped and replaced, and a bone graft may be used to repair defects.

Preoperative workup includes neuroimaging (CT or MRI) and standard labs, with informed consent obtained from the parents. Postoperative care includes ICU or step-down monitoring for airway and neurologic status, pain control, and wound care. Outpatient follow-up at 2 weeks, 3 months, and 1 year assesses head shape, neurologic development, and graft integration.

Coding Specifications

Modifier	Description	When to Use
`26`	Professional component	Use when billing only the physician professional component of a related diagnostic service, if applicable.
`50`

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

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-62010-DEPRESSED-SKULL-FRACTURE-ELEVATION-DURA-REPAIR

CPT 62010: Elevation of Depressed Skull Fracture with Dura Repair

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

CPT 62148: Cranioplasty Using Previously Stored Autologous Cranial Bone Graft

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

CPT 62145: Cranial Reconstruction with Brain Tissue Repair

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

CPT 62142: Removal of Bone Flap or Prosthetic Skull Plate

CPT-62143-CRANIAL-BONE-FLAP-OR-PROSTHETIC-SKULL-PLATE-REPLACEMENT

CPT 62143: Replacement of Bone Flap or Prosthetic Skull Plate

CPT-62120-CRANIAL-VAULT-REPAIR-SKULL-DEFECT-RECONSTRUCTION

CPT 62120: Cranial Vault Repair and Skull Defect Reconstruction

CPT-62115-CRANIAL-SKULL-REDUCTION-CRANIOMEGALY

CPT 62115: Reduction of Enlarged Skull (Craniomegaly)

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

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

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Taxonomy Code	Specialty	Notes
207Q00000X	Pediatric Neurosurgery	Pediatric neurosurgeons commonly perform cranial vault remodeling for craniosynostosis and craniomegaly.
2080P0206X	Pediatric Plastic Surgery	Craniofacial or pediatric plastic surgeons often collaborate on contouring and reconstruction, including bone grafting.
208000000X	General Surgery (Neurosurgery focus)	Neurosurgeons with cranial specialization who perform complex cranial reconstructions.
207L00000X	Neurological Surgery	Adult neurosurgeons may perform cranial remodeling in older patients with acquired craniomegaly or post-traumatic deformity.
2084P0800X	Plastic and Reconstructive Surgery	Reconstructive surgeons involved when substantial bone grafting or contouring is required.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q75.0`	Craniosynostosis	Premature fusion of cranial sutures leading to skull deformity; primary indication for cranial vault remodeling.
`Q67.3`	Craniomegaly	Enlarged skull contour that may require bone removal and reshaping.
`S02.8XXA`	Fracture of other specified skull and facial bones, initial encounter	Post-traumatic skull deformity where remodeling or repair with bone graft may be indicated.
`M96.89`	Other postoperative complications and disorders of musculoskeletal system and connective tissue, not elsewhere classified	Used when postoperative complications related to cranial reconstruction occur and require further surgical management.
`G93.2`	Benign intracranial hypertension (pseudotumor cerebri)	When raised intracranial pressure with skull deformity is a contributing factor and decompressive remodeling is considered.
`Q67.8`	Other congenital deformities of skull and facial bones	Miscellaneous congenital cranial deformities amenable to reconstructive remodeling.
`T90.2`	Sequelae of skull fracture	Late deformity or defect after healing that may require corrective cranial vault remodeling.
`K71.2`	Toxic liver disease with chronic persistent hepatitis	Example of a comorbid condition that may affect perioperative management (included only for completeness)

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`21175`	Reconstruction of major cranial or facial bone defect; with bone graft, local tissue flap, or prosthesis	May be performed concurrently or subsequently when large calvarial defects require structural grafting beyond standard remodeling.
`61618`	Craniectomy or craniotomy for cranial remodeling (distinct craniofacial codes vary)	Related cranial access codes used for exposure; may be listed alongside or as technique descriptors depending on documentation (note: technique-specific code selection depends on operative details).
`15732`	Muscle, myocutaneous, or fasciocutaneous flap with microvascular anastomosis (if applicable)	Used if complex soft-tissue reconstruction with free flap is required in addition to bone work.
`22830`	Exploration of spinal fusion site (example of unrelated code set)	Data not directly applicable; included only when additional procedures are performed — otherwise, Data not available in the input.
`11043`	Debridement, subcutaneous tissue, muscle and fascia when wound complications occur	May be used for postoperative wound debridement if infection or necrosis requires operative management.

Note: If specific related CPT codes were provided in the input, they would be listed above. Data not available in the input.

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