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Official Description

Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 61512 involves a craniectomy, trephination, and bone flap craniotomy specifically for the excision of a meningioma located in the supratentorial region of the brain. The supratentorial area is defined as the portion of the brain situated above the tentorium cerebelli, which is a fold of the dura mater that separates the cerebrum's frontal and occipital lobes from the cerebellum. A craniectomy is a surgical procedure that entails the creation of scalp flaps, followed by the drilling of burr holes in the skull. The bone between these burr holes is then meticulously cut using a surgical saw or craniotome, allowing for the elevation and removal of a bone flap, which may be done temporarily or permanently. Trephination is a technique that involves the excision of a circular section of the skull, while craniotomy refers to the broader process of creating both scalp and bone flaps to gain access to the brain region affected by the tumor. In contrast to CPT® Code 61510, which pertains to the excision of brain tumors or lesions other than meningiomas, CPT® Code 61512 specifically targets meningiomas, which are tumors arising from the meninges—the protective membranes covering the brain and spinal cord. Meningiomas are typically slow-growing and benign, although malignant variants can occur, albeit infrequently. During the procedure, the meningioma is exposed, and the blood vessels supplying it are identified and coagulated to prevent excessive bleeding. The tumor is then completely resected, including any affected dura mater and any hyperostotic bone. Following the excision, the dura is repaired using either an autograft from the pericranium or fascia lata, or a synthetic dural substitute may be employed. The final steps involve repairing the skull defect, reapproximating the scalp flap, and closing the skin incision, ensuring a thorough and careful approach to the surgical site.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 61512 is indicated for the excision of a meningioma located in the supratentorial region of the brain. The following conditions may warrant this surgical intervention:

  • Meningioma Diagnosis The presence of a meningioma, which is a tumor arising from the meninges, the protective membranes covering the brain and spinal cord.
  • Symptoms of Increased Intracranial Pressure Symptoms such as headaches, nausea, vomiting, or visual disturbances that may indicate the presence of a meningioma causing increased pressure within the skull.
  • Neurological Deficits Neurological symptoms such as seizures, weakness, or sensory changes that may be attributed to the mass effect of the meningioma on surrounding brain structures.
  • Imaging Findings Abnormal findings on imaging studies, such as MRI or CT scans, that reveal the presence of a meningioma requiring surgical intervention for removal.

2. Procedure

The procedure for CPT® Code 61512 involves several critical steps to ensure the successful excision of the meningioma:

  • Step 1: Preparation and Anesthesia The patient is positioned appropriately, and general anesthesia is administered to ensure comfort and immobility during the procedure. The surgical site is then prepared and draped in a sterile manner.
  • Step 2: Scalp Flap Creation An incision is made in the scalp to create a scalp flap. This involves careful dissection to preserve the underlying tissues and blood supply.
  • Step 3: Burr Hole Drilling Burr holes are drilled into the skull to facilitate access to the underlying brain. These holes are strategically placed to allow for the subsequent cutting of the bone.
  • Step 4: Bone Flap Elevation The bone between the burr holes is cut using a surgical saw or craniotome. A bone flap is then elevated and removed, providing access to the brain tissue beneath.
  • Step 5: Tumor Exposure The dura mater is incised, and a dural flap is created to expose the meningioma. The surgical team utilizes an operative microscope to visualize the tumor and surrounding structures clearly.
  • Step 6: Tumor Resection The meningioma is carefully dissected from the surrounding brain tissue. The arterial feeders to the tumor are identified and coagulated to minimize bleeding. The goal is to completely resect the tumor, including any involved dura and hyperostotic bone.
  • Step 7: Dural Repair After the tumor has been excised, the dura is repaired using an autograft of pericranium or fascia lata, or a synthetic dural substitute may be utilized to ensure proper closure.
  • Step 8: Closure of Skull Defect The skull defect is addressed, and the bone flap is either replaced and secured with steel sutures or plugged with bone wax or silicone as needed.
  • Step 9: Scalp and Skin Closure The scalp flap is reapproximated, and the skin incision is closed using appropriate suturing techniques to promote healing.

3. Post-Procedure

Post-procedure care following the excision of a meningioma includes monitoring the patient for any signs of complications, such as infection, bleeding, or neurological deficits. Patients are typically observed in a recovery area until they are stable. Pain management is provided as needed, and the surgical site is monitored for proper healing. Follow-up imaging may be required to assess for any residual tumor or complications. Rehabilitation services may also be recommended to address any neurological deficits that may arise post-surgery. The patient will receive specific instructions regarding activity restrictions, wound care, and follow-up appointments to ensure optimal recovery.

Short Descr CRNEC TREPH EXC MNGIOMA STTL
Medium Descr CRNEC TREPH BONE FLAP CRNOT EXC MENINGIOMA STTL
Long Descr Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 1 - Incision and excision of CNS

This is a primary code that can be used with these additional add-on codes.

0735T Add On Code MPFS Status: Carrier Priced APC N Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with primary craniotomy (List separately in addition to code for primary procedure)
69990 Addon Code MPFS Status: Restricted APC N ASC N1 PUB 100 CPT Assistant Article 1Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)
GC This service has been performed in part by a resident under the direction of a teaching physician
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
AG Primary physician
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
LT Left side (used to identify procedures performed on the left side of the body)
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
RT Right side (used to identify procedures performed on the right side of the body)
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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2025-01-01 Changed Short and Medium Descriptions changed.
Pre-1990 Added Code added.
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