CPT 62146 Autologous Cranioplasty Reimbursement | OpenPayer

Summary & Overview

CPT 62146: Autologous Cranioplasty for Skull Defect ≤5 cm

CPT code 62146 represents autologous cranioplasty: surgical repair of a skull defect no larger than 5 cm using bone harvested from the same patient. This procedure addresses cranial defects from trauma, tumors, congenital conditions, or other disease processes and is a key reconstructive option in neurosurgery and craniofacial practice. Nationally, accurate use of this code affects clinical documentation, surgical quality measurement, and appropriate payment for complex reconstructive cranial care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of coding intent and clinical context, typical sites of service, and common modifiers used with this procedure. Readers will find benchmarks on utilization and reimbursement patterns, guidance on documentation elements that support code assignment, and relevant policy or coverage themes that affect access and billing for autologous cranioplasty. The material is intended for clinicians, coding professionals, and policy analysts seeking a national perspective on coding practice, documentation expectations, and payer-related considerations for CPT code 62146. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 62146cranioplastyautologous bone graftneurosurgerycranial reconstructionsurgical codingoperative procedurehospital billing

Billing Code Overview

CPT code 62146 describes surgical repair of a skull bone defect no larger than 5 cm using bone tissue harvested from another part of the same patient and transferred to the cranium. This autologous cranioplasty resolves cranial defects that may result from depressed skull fractures, congenital abnormalities, tumors, or other trauma or disease.

Service type: Surgical cranial reconstruction using autologous bone graft
Typical site of service: Inpatient or outpatient hospital operating room; specialized surgical centers for neurosurgery or craniofacial surgery

Clinical & Coding Specifications

Clinical Context

A 42-year-old male presents after a motor vehicle collision with a depressed right frontal skull fracture and underwent initial emergent neurosurgical evacuation of an intracranial hematoma. After infection risk is controlled and intracranial pressure has normalized, the patient returns to the operating room for definitive reconstruction of a 3.5 cm cranial bone defect. The neurosurgeon harvests autologous split-thickness calvarial bone from the parietal region and fashions it to fit the defect, securing the graft to the defect site to restore cranial contour and protect the underlying brain. The clinical workflow includes preoperative imaging review (CT head), informed consent, intraoperative graft harvest and fixation, perioperative antibiotics, postoperative monitoring for graft viability and wound healing, and outpatient follow-up with wound checks and repeat imaging as indicated.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal services	Use when reporting the usual, uncomplicated service by the primary surgeon.
`22`	Increased procedural services	Use when work required is substantially greater than usual (extensive dissection, prolonged operative time).

CPT 62142: Removal of Bone Flap or Prosthetic Skull Plate

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

CPT 62143: Replacement 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-62005-ELEVATION-DEPRESSED-SKULL-FRACTURE

CPT 62005: Elevation of Depressed Skull Fracture

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

CPT 62120: Cranial Vault Repair and Skull Defect Reconstruction

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

CPT 62100: Cranial Dural Repair for Cerebrospinal Fluid Leak

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

CPT 62010: Elevation of Depressed Skull Fracture with Dura Repair

CPT-62115-CRANIAL-SKULL-REDUCTION-CRANIOMEGALY

CPT 62115: Reduction of Enlarged Skull (Craniomegaly)

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

CPT 62148: Cranioplasty Using Previously Stored Autologous Cranial Bone Graft

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Taxonomy Code	Specialty	Notes
207L00000X	Neurological Surgery	Primary specialty performing cranial reconstruction and autologous bone grafting.
2080P0003X	Plastic Surgery	Reconstructive techniques for cranial contour restoration and soft tissue management.
2084N0400X	Oral and Maxillofacial Surgery	May participate for complex craniofacial defects involving facial skeleton.
207NP3000X	Neurology (not typical surgeon)	Rarely involved for neurological assessment and postoperative management.
103T00000X	Physician Assistant	Commonly assists in perioperative care and follow-up visits.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S02.81XA`	Fracture of other specified skull bones, initial encounter	Depressed skull fractures are a common indication for autologous cranioplasty to repair bone defects.
`S02.91XA`	Unspecified fracture of skull, initial encounter	Used when skull fracture type is not otherwise specified leading to bone loss or depression requiring repair.
`Q67.4`	Craniosynostosis, unspecified	Congenital skull defects or deformities that may require reconstruction using bone grafting techniques.
`C71.9`	Malignant neoplasm of brain, unspecified	Resection of intracranial tumors can create skull defects that are subsequently repaired with autologous bone.
`T81.4XXA`	Infection following a procedure, initial encounter	Postoperative wound or bone infection may necessitate delayed reconstruction once cleared.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61790`	Excision or drainage of intracranial hematoma; subdural or epidural	May be performed prior to cranioplasty during initial trauma management when hematoma evacuation is required.
`61582`	Craniectomy for access to brain (e.g., tumor, trauma)	Often performed earlier to treat the underlying intracranial pathology that resulted in a skull defect later repaired by cranioplasty.
`20930`	Allograft, morselized or placement of osteopromotive material, for spine or other bone grafting (includes demineralized bone matrix)	May be billed when adjunctive graft substitutes are used in addition to or instead of autologous bone.
`21210`	Reconstruction, mandible or maxilla; contouring, local tissue rearrangement (separate craniofacial reconstructive code)	Relevant when adjacent craniofacial reconstruction is performed in the same operative setting.
`21248`	Reconstruction of cranial or facial bone; with bone graft, local or distant donor site	Related reconstructive code for larger or more complex cranial vault reconstruction beyond small autologous grafts.

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