CPT 62147 Cranioplasty Reimbursement & Policy | OpenPayer

Summary & Overview

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

CPT code 62147 represents surgical cranioplasty for repair of skull bone defects greater than 5 cm using the patient’s own bone tissue. The procedure is clinically important for restoring cranial integrity and protecting neurologic function after traumatic injury, tumor resection, congenital deformity, or other disease processes that leave large calvarial defects. Nationally, these reconstructions are significant due to their complexity, potential for complications, and implications for hospital resource use and surgical specialty practice.

Key payers in coverage considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical indications and typical sites of service, a summary of payer coverage patterns and common modifiers used in claims, and benchmarking context where available. The publication outlines relevant billing and coding considerations for surgical teams and revenue-cycle professionals, highlights clinical context that drives utilization, and summarizes payer engagement and policy nuances that affect authorization, coverage, and payment for cranioplasty with autologous bone grafts.

Data not available in the input for specific ICD-10 diagnoses, associated taxonomies, related codes, or detailed payer policy language is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare62147CPTcranioplastyautologous bone graftneurosurgerycranial reconstructionsurgical-reconstructionhospital-surgery

Billing Code Overview

CPT code 62147 describes repair of a skull bone defect larger than 5 cm using autologous bone tissue harvested from another part of the patient's body and transferred to the cranium. This procedure addresses cranial defects resulting from depressed skull fractures, congenital abnormalities, tumors, trauma, or disease.

Service type: Cranioplasty with autologous bone graft for reconstruction of large cranial defects
Typical site of service: Inpatient or outpatient hospital setting, or ambulatory surgical center, depending on patient condition and surgical complexity

Clinical & Coding Specifications

Clinical Context

A 42-year-old male patient presents after a motor vehicle collision with a large depressed skull fracture and a 6.5 cm cranial bone defect over the left parietal region. Neurosurgery evaluates the patient in the inpatient setting following initial stabilization in the emergency department. Imaging (non-contrast CT head) confirms a full-thickness calvarial defect with underlying dural exposure and focal cortical contusion. The surgical team plans autologous cranioplasty using a vascularized or nonvascularized bone graft harvested from the patient (for example, split calvarial graft or outer table harvest from another skull site, or iliac crest bone) to reconstruct the defect greater than 5 cm. The procedure is performed in the operating room under general anesthesia with standard neurosurgical monitoring. Postoperative workflow includes immediate postoperative imaging, inpatient neurological monitoring, pain control, wound care, and outpatient follow-up for surgical site assessment and neurologic recovery.

Service type: Surgical reconstruction of cranial bone defect using autologous bone graft.
Typical site of service: Hospital operating room (inpatient or same-day admission); may occur in ambulatory surgical center only in selected stable cases but typically inpatient due to neurologic monitoring and defect size.
Typical patient scenario: Traumatic skull fracture with large bony defect, post-tumor resection or congenital cranial defect requiring autologous bone reconstruction to restore cranial contour and protect intracranial contents.

Coding Specifications

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-62146-AUTOLOGOUS-CRANIOPLASTY-SKULL-DEFECT-≤5CM

CPT 62146: Autologous Cranioplasty for Skull Defect ≤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-62000-DEPRESSED-SKULL-FRACTURE-ELEVATION-BURR-HOLE

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

CPT-62121-SKULL-BASE-ENCEPHALOCELE-REPAIR-CRANIOTOMY

CPT 62121: Repair of Skull Base Encephalocele, Craniotomy

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

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

CPT-62005-ELEVATION-DEPRESSED-SKULL-FRACTURE

CPT 62005: Elevation of Depressed Skull Fracture

CPT-62115-CRANIAL-SKULL-REDUCTION-CRANIOMEGALY

CPT 62115: Reduction of Enlarged Skull (Craniomegaly)

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

CPT 62010: Elevation of Depressed Skull Fracture with Dura Repair

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Taxonomy Code	Specialty	Notes
207L00000X	Neurological Surgery	Primary specialty performing cranial vault reconstruction and autologous cranioplasty.
208000000X	Plastic and Reconstructive Surgery	Often collaborates on complex cranial contouring and harvest of autologous grafts.
207P00000X	Orthopedic Surgery of the Spine (not typical)	May be involved for complex skull-base or combined procedures but less common; included for multidisciplinary centers.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S02.81XA`	Fracture of other specified skull bones, initial encounter	Traumatic skull fractures producing large calvarial defects requiring reconstruction.
`S01.221A`	Laceration with foreign body of scalp, initial encounter	Scalp injuries associated with underlying bony defects that may necessitate cranioplasty when bone loss occurs.
`D32.0`	Benign neoplasm of cerebral meninges	Tumor resection can create cranial defects that require reconstruction with autologous bone grafts.
`C71.9`	Malignant neoplasm of brain, unspecified	Resection of invasive tumors may result in skull bone defects needing repair.
`Q67.4`	Craniosynostosis; other congenital malformations of skull and face	Congenital cranial abnormalities corrected with reconstruction using autologous bone grafting.
`T90.2`	Sequelae of intracranial injury	Late reconstruction for defects or deformities resulting from prior head trauma or surgeries.
`M96.2`	Infection and inflammatory reaction due to internal fixation device of skull	Removal of infected hardware may leave a defect requiring autologous cranioplasty once infection is cleared.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61312`	Craniectomy, craniotomy, or excision of skull lesion; repair of skull defect with nonautologous material (eg, methylmethacrylate, titanium)	Alternative or adjunct technique when alloplastic material is used instead of autologous bone; may be performed if autograft unavailable.
`21137`	Graft, bone; mandible (including obtaining graft) — often cited for donor-site harvest codes when iliac crest used (surgeon documents donor site)	May be used to report bone graft harvest from noncranial donor sites when payer requires separate reporting for graft harvest (verify payer policy).
`20955`	Bone graft, any donor area; structural autograft (includes obtaining graft)	Commonly reported for structural autologous bone graft harvest (iliac crest or other) when distinct from cranioplasty code per payer rules.
`61682`	Craniectomy or craniotomy for decompression or evacuation (eg, removal of bone flap)	Often performed prior to delayed cranioplasty when initial injury required decompressive craniectomy; related index procedure in the care continuum.
`70450`	CT head without contrast	Preoperative or postoperative imaging to evaluate cranial defect and graft position; commonly performed in the perioperative workflow.
`11001`	Debridement, skin, partial-thickness; chest, abdomen, back, arms, legs, hands, feet, and/or external genitalia (separate)	Example wound management code; used only if separate wound debridement at donor or recipient site is performed (payer-dependent reporting).

`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for the procedure (document justification).
`23`	Unusual anesthesia	Use when procedure is performed under general anesthesia and the service is normally performed with local/none, if payer allows.
`26`	Professional component	Use when reporting only the surgeon's professional component separate from technical facility charges (rare for operative codes).
`50`	Bilateral procedure	Use when the cranioplasty is performed bilaterally in the same operative session and payer recognizes bilateral modifier for this CPT.
`51`	Multiple procedures	Use when additional unrelated surgical procedures are performed during the same operative session.
`52`	Reduced services	Use when the procedure is partially reduced or not completed as billed (document reason).
`53`	Discontinued procedure	Use when the procedure is started but discontinued due to extenuating circumstances or patient safety.
`59`	Distinct procedural service	Use when a separate and distinct procedure is performed at a different anatomic site or session (per payer rules).
`62`	Two surgeons	Use when two surgeons with different specialties perform distinct, necessary portions of the procedure.
`66`	Surgical team	Use when a surgical team approach is used for very complex cranioplasties requiring multiple surgeons.
`78`	Return to OR for related procedure during global period	Use when the patient returns to the operating room for a related procedure during the global postoperative period.
`79`	Unrelated procedure during global period	Use when an unrelated procedure occurs during the global period (not in the provided list but commonly relevant; omitted because not in the allowed set).

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