CPT 63702 Meningocele Repair Reimbursement | OpenPayer

Summary & Overview

CPT 63702: Surgical Repair of Meningocele (>5 cm)

CPT code 63702 represents surgical repair of a meningocele — a congenital neural tube defect in which the meninges herniate through a defect in the skull or spinal column to form a cerebrospinal fluid–filled sac exceeding 5 cm in diameter. This procedure is clinically significant because it addresses potential neurologic compromise, infection risk, and long-term developmental outcomes in affected infants and children. Nationally, accurate coding of complex pediatric neurosurgical procedures supports appropriate clinical tracking and hospital resource planning.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical intent, typical sites of service, and the kinds of policy and billing considerations that commonly affect coverage and payment for major congenital neurosurgical repairs. The publication covers benchmarks where available, relevant policy updates impacting surgical authorization and inpatient versus outpatient classification, and clinical context regarding indications and procedural scope. Data not available in the input will be noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 63702neurosurgerycongenital defectsmeningocelepediatric surgerysurgical repairhospital inpatientprocedure coding

Billing Code Overview

CPT code 63702 describes surgical repair of a meningocele — a birth defect in which the meninges protrude through a skull or spinal column defect to form a fluid-filled sac. The procedure is for a meningocele with a diameter greater than 5 cm.

Service Type: Surgical repair of congenital neural tube defect (meningocele)

Typical Site of Service: Inpatient or outpatient hospital surgical setting, or specialized pediatric neurosurgery center

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

An infant or young child presents with a congenital posterior midline cranial or spinal soft-tissue sac that contains meninges and cerebrospinal fluid consistent with a meningocele greater than 5 cm in diameter. The patient is evaluated by pediatric neurosurgery with preoperative neuroimaging (MRI brain and/or spine) demonstrating a defect in the skull or vertebral arch with a CSF‑filled sac and intact neural placode. The clinical workflow includes preoperative anesthesia clearance, perioperative antibiotics, operative repair under general anesthesia with neurosurgical exposure of the sac, careful dissection and preservation of neural elements, excision or reduction of the meningeal sac, watertight dural closure, reconstruction of bony or soft tissue defects as indicated, placement of drains if needed, and postoperative monitoring for CSF leak, infection, hydrocephalus, and neurological status. Typical site of service is an inpatient operating room at a tertiary pediatric medical center or hospital with pediatric neurosurgery capability. Service type: open surgical repair of a congenital meningocele (>5 cm). Typical patient scenario: newborn or pediatric patient with congenital meningocele referred from neonatology or pediatric surgery for definitive neurosurgical repair, often scheduled electively after initial stabilization, or urgently if sac is leaking or infected.

Coding Specifications

Modifier	Description	When to Use
`00`	No specific modifier (neutral)	Use when no other modifier applies to the claim.

Related Codes

CPT-63710-DURAL-GRAFT-FOR-DURAL-CLOSURE

CPT 63710: Dural Graft for Closure of Dural Opening

CPT-63704-MYELOMENINGOCELE-REPAIR-LESION-LESS-THAN-5CM

CPT 63704: Repair of Myelomeningocele (lesion <5 cm)

CPT-63700-MENINGOCELE-REPAIR-SURGICAL-REPAIR-MENINGEAL-SAC

CPT 63700: Repair of Meningocele (meningeal sac under 5 cm)

CPT-63706-MYELOMENINGOCELE-REPAIR-LARGE-DEFECT

CPT 63706: Myelomeningocele Repair, Defect >5 cm

CPT-63709-DURAL-REPAIR-CSF-LEAK-REPAIR

CPT 63709: Dural Repair for CSF Leak

CPT-63707-DURAL-REPAIR-CSF-LEAK

CPT 63707: Dural Repair for Cerebrospinal Fluid Leak

Taxonomy Code	Specialty	Notes
208000000X	Pediatric Neurological Surgery	Pediatric neurosurgeons commonly perform meningocele repair.
207P00000X	Pediatric Surgery	Pediatric surgeons may be involved in multispecialty cases or soft tissue reconstruction.
207L00000X	Plastic and Reconstructive Surgery	Plastic surgeons may assist for soft tissue or scalp/flap reconstruction.
207K00000X	General Surgery	General surgeons may be involved in settings without pediatric subspecialists for older patients.
2084P0800X	Neurological Surgery	Adult neurosurgeons perform meningoceles in older children/adolescents when pediatric specialists are unavailable.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Q01`	Encephalocele	Midline skull defect with herniation of intracranial contents; clinically overlaps with cranial meningocele/encephalocele repairs.
`Q05.0`	Lumbar meningomyelocele with hydrocephalus	Spinal neural tube defect related to meningomyelocele; may coexist or require coordinated care for CSF management.
`Q05.1`	Lumbar meningomyelocele without hydrocephalus	Spinal meningocele/meningomyelocele diagnosis relevant to spinal repairs.
`Q05.9`	Spina bifida, unspecified	Underlying neural tube defect that can present with meningocele.
`G91.0`	Communicating hydrocephalus	Hydrocephalus may be associated with cranial meningoceles and influence perioperative management and need for shunting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`61520`	Repair of encephalocele or meningocele; cranial (intracranial) approach	Alternative CPT code for cranial meningocele/encephalocele repair depending on approach and extent; may be used for intracranial defects.
`61512`	Repair of cranial meningocele or encephalocele; transcranial with repair of dura and skull	Used for cranial defects requiring dural and bony reconstruction; may be performed in conjunction or instead of `63702` depending on anatomy.
`63701`	Repair of meningocele, diameter 5 cm or less	Closely related code for smaller lesions; distinction by sac diameter determines correct code selection.
`62270`	Spinal puncture, diagnostic or therapeutic (lumbar puncture)	May be used perioperatively for CSF sampling or pressure management, though not typically billed with the primary repair.
`69990`	Microsurgical techniques, requiring use of an operating microscope	May be reported when microsurgical magnification is integral and separately reportable per payer policy.
`21246`	Reconstruction of calvarial defect (e.g., bone graft, cranioplasty)	Used when bony reconstruction or cranioplasty is required during meningocele repair.