🧠 CPT 61510 — Craniectomy, Trephination, Bone Flap Craniotomy for Excision of Brain Tumor, Supratentorial, Except Meningioma
Quick Reference
wRVU: 30.06¹ | Global Period: 090 | Assistant Payable: Yes (per CMS PFS assistant-at-surgery indicator) | Bilateral Indicator: 0 Rule: CPT 61510 carries the highest wRVU of the supratentorial excision family, reflecting the complexity of open cranial tumor resection. Because it is not modifier -51 exempt, expect payer-side multiple-procedure reductions when reported with add-on codes like stereotactic navigation or intraoperative monitoring. It excludes meningioma excision — that scenario reports to 61512 instead.
📋 Clinical Description
CPT 61510 describes an open craniectomy or bone-flap craniotomy performed specifically to excise a non-meningioma brain tumor located in the supratentorial compartment — the region above the tentorium cerebelli that houses the cerebral hemispheres. The surgeon creates burr holes, elevates a bone flap, opens the dura, and uses microsurgical technique to resect the mass while preserving eloquent cortex and vasculature. Unlike 61304, which is reported for purely exploratory craniotomy without tumor removal, 61510 requires an actual excisional intent and outcome.
This code sits within a tightly clustered excision family distinguished almost entirely by pathology rather than technique: 61510 is used for gliomas, metastases, and other non-meningioma masses, while 61512 is the identical approach reported when the lesion is confirmed as a meningioma, and 61514 is used when the target is an abscess rather than a neoplasm. Coders should never default to 61510 based on operative approach alone — the pathology report or intraoperative frozen section is often the deciding factor when the pre-op differential includes meningioma versus glioma.
This procedure may be performed in the following clinical contexts:
- Newly diagnosed supratentorial glioma or metastatic lesion — resection performed for symptom relief, tissue diagnosis, and cytoreduction prior to adjuvant therapy.
- Recurrent tumor after prior resection or radiation — reoperation through the original or an extended craniotomy, often billed with modifier -78 if within the prior global period.
- Tumor causing refractory seizures or rising intracranial pressure — urgent or semi-urgent resection to relieve mass effect and control neurologic decline.
- Awake craniotomy with intraoperative mapping — resection near eloquent cortex (motor, speech) using cortical stimulation to preserve function, still reported as 61510 regardless of the mapping technique used.
🔬 Anatomical & Procedural Considerations
| Variant | Mechanism | Key Notes |
|---|---|---|
| Frontal/anterior approach | Bone flap centered over the frontal or frontotemporal region; the tumor is accessed through a relatively low-risk corticotomy given the frontal lobe’s greater functional tolerance. | Commonly used for frontal gliomas and metastases; lower risk of postoperative motor or speech deficit than parietal or dominant temporal approaches. |
| Parietal/temporal approach | Bone flap positioned over the parietal or temporal convexity; often requires intraoperative neuronavigation and, when near the dominant hemisphere, awake mapping to protect language and sensorimotor function. | Higher risk of postoperative deficit; frequently paired with add-on codes for neuromonitoring or stereotactic computer-assisted navigation. |
| Interhemispheric/parasagittal approach | Bone flap crosses or approaches the midline; the falx cerebri is retracted to access deep or medial supratentorial lesions. | Carries added risk to the superior sagittal sinus and bridging veins; documentation should clearly describe sinus preservation technique. |
Clinical Pearl
The single most common denial driver for 61510 is a mismatch between the pre-op differential and the final pathology. If the operative note lists “possible meningioma” but final pathology confirms a different tumor type, code to the confirmed pathology (61510), not the pre-op impression. Always hold final coding until the pathology report is available for inpatient claims, since MS-DRG assignment and HCC capture both depend on the confirmed neoplasm behavior and site.
✅ Procedure Includes
- Scalp incision, hemostasis, and reflection of the scalp flap.
- Burr hole placement and elevation of the bone flap (craniotomy) or removal without replacement (craniectomy).
- Durotomy and dural management, including primary closure or graft placement.
- Cortical mapping or use of intraoperative navigation when performed as an integral part of the same session (unless separately reportable add-on codes apply).
- Microsurgical tumor dissection and excision from surrounding brain parenchyma.
- Hemostasis of the resection cavity and closure of dura, bone flap, and scalp.
❌ Excludes / Do Not Report Together
| Code | Description | Relationship |
|---|---|---|
| 61512 | Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial | Same anatomic approach and technique as 61510, but reserved exclusively for confirmed meningioma pathology. These two codes are mutually exclusive for a single lesion — never report both for the same tumor. |
| 61514 | Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial | Reported when the surgical target is an infectious abscess rather than a neoplasm; distinguished by indication, not technique. |
| 61516 | Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial | Used for cystic lesions (e.g., arachnoid cyst) rather than solid tumor; do not report with 61510 for the same lesion. |
| 61518 | Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor | The infratentorial counterpart to 61510 — choose based on tumor location relative to the tentorium, not surgical approach. |
Bundling Alert
CPT 61510 carries a 90-day global surgical package, so any related E/M visits, dressing changes, or staged procedures within that window are bundled unless a valid modifier (-24, -58, -78, -79) documents medical necessity for separate payment. Watch for NCCI edits with stereotactic navigation add-on codes and intraoperative neurophysiologic monitoring codes — these are separately payable only when medical necessity and distinct personnel/documentation requirements are met, and auditors frequently flag claims where navigation is billed but the operative note doesn’t independently support its use.
🌳 Code Tree — Surgery: Nervous System (Skull, Meninges, and Brain)
61304-61576 Surgery: Nervous System — Skull, Meninges, and Brain
│
├── 61304-61305 Craniectomy or Craniotomy, Exploratory
│ ├── 61304 Craniectomy or craniotomy, exploratory; supratentorial
│ └── 61305 Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)
│
├── 61500-61516 Excision, Supratentorial
│ ├── 61500 Craniectomy; for osteomyelitis or bone flap infection
│ ├── 61512 Craniectomy, trephination, bone flap craniotomy; for excision of meningioma, supratentorial
│ ├── ▶▶ 61510 ◀◀ Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor, supratentorial, except meningioma ← YOU ARE HERE (Global: 090)
│ ├── 61514 Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess, supratentorial (Global: 090)
│ └── 61516 Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of cyst, supratentorial (Global: 090)
│
└── 61518-61520 Excision, Infratentorial or Posterior Fossa
├── 61518 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor
└── 61520 Craniectomy for excision of brain tumor, infratentorial or posterior fossa; cerebellopontine angle tumor💰 RVU & Reimbursement Profile
| Component | Value |
|---|---|
| Work RVU | 30.06² — CMS 2026 National Physician Fee Schedule Relative Value File (RVU26A/RVU26B) |
| Global Period | 090 — 90-day major surgical global package |
| Bilateral Indicator | 0 — the 150% bilateral payment adjustment does not apply; the brain is not a paired structure for billing purposes |
| Assistant Surgeon | Payable — commonly used given the complexity of open cranial tumor resection |
| Co-Surgeon | Payable with documentation — two surgeons of different specialties (e.g., neurosurgery plus ENT for a combined approach) may report with modifier -62 |
| Team Surgery | Rarely applicable — reserved for unusually complex multi-specialty resections |
| PC/TC Split | 0 — not a PC/TC-split code; this is a global surgical procedure, not a diagnostic test with separate professional/technical components |
| Modifier -51 Exempt | No — standard multiple-procedure reduction rules apply when reported with other same-session procedures |
| Anesthesia | General anesthesia; typically crosswalks to ASA base unit values in the 61510-61576 neurosurgical range |
Bilateral Billing Rules
Because the brain is a single midline structure and 61510 targets a specific supratentorial lesion rather than a paired anatomic site, -RT, -LT, and -50 modifiers are not applicable to this code. If bilateral hemisphere tumors require separate excisions, report the additional resection with modifier -59 or the appropriate X{EPSU} modifier to indicate a distinct procedural service, not -50.
🏷️ Modifier Reference
| Modifier | Name | When to Apply |
|---|---|---|
| -22 | Increased Procedural Services | Use when operative time or complexity substantially exceeds the typical case — e.g., extensive adhesions from prior surgery or an unusually large resection cavity. Requires strong operative-note documentation of the added work. |
| -24 | Unrelated E/M During Global Period | Applies when the surgeon evaluates the patient for an unrelated condition during the 90-day global window following 61510. |
| -25 | Significant, Separately Identifiable E/M | Rarely applicable to 61510 itself, but may apply if a significant E/M service is furnished the same day as an unrelated minor procedure during the postoperative period. |
| -51 | Multiple Procedures | Appended to secondary procedures when 61510 is reported with other same-session, separately payable procedures. |
| -58 | Staged or Related Procedure | Use for a planned second-stage resection or a related procedure performed during the 90-day global period. |
| -62 | Two Surgeons | Reported by each surgeon when two physicians of different specialties work together as primary surgeons on distinct portions of the same procedure. |
| -78 | Unplanned Return to OR | Applies when the patient returns to the OR for a related complication (e.g., postoperative hemorrhage) within the global period. |
| -79 | Unrelated Procedure During Global Period | Applies when an unrelated surgical procedure is performed by the same surgeon during the 90-day window. |
| -80 | Assistant Surgeon | Appended by the assisting surgeon; commonly payable given the complexity of open cranial tumor resection. |
🩺 Common ICD‑10‑CM Pairings
Primary Diagnosis Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| C71.9 | Malignant neoplasm of brain, unspecified | ✅ Yes | Use only when the specific lobe is not documented; specificity to lobe is preferred whenever the operative or pathology report supports it. |
| C71.1 | Malignant neoplasm of frontal lobe | ✅ Yes | Pairs with the frontal/anterior approach variant described above. |
| C71.2 | Malignant neoplasm of temporal lobe | ✅ Yes | Commonly seen with parietal/temporal approach resections requiring awake mapping. |
| C79.31 | Secondary malignant neoplasm of brain | ✅ Yes | Use for metastatic disease; sequence per ICD-10-CM guidelines relative to the primary malignancy if actively being treated during the same encounter. |
| D33.0 | Benign neoplasm of brain, supratentorial | ❌ No | Use when pathology confirms a benign, non-meningioma supratentorial tumor (e.g., low-grade glioma classified as benign behavior). |
Secondary Group
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| G40.909 | Epilepsy, unspecified, not intractable, without status epilepticus | ❌ No | Reported when seizures are a presenting symptom or documented comorbidity of the tumor. |
| G93.6 | Cerebral edema | ❌ No | Reported when documented as a distinct clinical finding contributing to severity, not as an inherent part of the tumor itself. |
Etiology / Complication
| ICD‑10 | Description | HCC? | Notes |
|---|---|---|---|
| G97.31 | Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure | ❌ No | Use only when the operative note documents an intraoperative hemorrhagic complication during the craniotomy itself. |
| G97.51 | Postprocedural hemorrhage of a nervous system organ or structure following a nervous system procedure | ❌ No | Use for a postoperative bleed identified after the craniotomy, distinct from the routine expected surgical bed changes. |
Coding Specificity Reminder
Always code the neoplasm to the most specific lobe or site the pathology and operative documentation support — C71.9 should be a last resort, not a default. Confirm laterality is not applicable to C71 category codes (no 5th character for side), and never assign a complication code from the G97 family unless the provider explicitly documents the complication as related to the procedure.
🏥 MS‑DRG Considerations
CPT 61510 groups to MDC 1 (Diseases and Disorders of the Nervous System) for inpatient stays.³ Encounters with a principal diagnosis of a primary or secondary brain neoplasm most commonly map to MS-DRG 025 (with MCC), 026 (with CC), or 027 (without CC/MCC) — Craniotomy and Endovascular Intracranial Procedures. When a major device is implanted (e.g., an intraoperative monitoring lead left in place, or a subdural grid) or the principal diagnosis qualifies as an acute complex CNS condition, the encounter can instead group to MS-DRG 023 or 024 (Craniotomy with Major Device Implant or Acute Complex CNS Principal Diagnosis, with/without MCC). No NCD specifically governs CPT 61510, and a search of Noridian JE/JF LCD policy did not return an active, code-specific LCD for craniotomy/craniectomy tumor excision — coverage is governed by standard reasonable-and-necessary documentation (imaging confirming a supratentorial mass, an operative report supporting excision, and pathology confirmation) rather than a frequency- or diagnosis-list-limited LCD.⁴
🔧 ICD‑10‑PCS Equivalents
| PCS Code | Full Description | Modality |
|---|---|---|
| 00B00ZZ | Excision of Brain, Open Approach | Open |
| 00BD0ZZ | Excision of Cerebral Hemisphere, Open Approach | Open |
| 00B03ZZ | Excision of Brain, Percutaneous Approach | Percutaneous |
| 00BD3ZZ | Excision of Cerebral Hemisphere, Percutaneous Approach | Percutaneous |
PCS Character Analysis (primary code: 00B00ZZ)
| Position | Character | Value | Definition |
|---|---|---|---|
| 1 | Section | 0 | Medical and Surgical — the general surgical procedures section covering the vast majority of inpatient operative reporting. |
| 2 | Body System | 0 | Central Nervous System — reflects the brain as the anatomic target of the procedure. |
| 3 | Root Operation | B | Excision — cutting out a portion of the body part without replacement, matching the partial-tumor-removal intent of 61510. |
| 4 | Body Part | 0 | Brain — the general body part value; use “Cerebral Hemisphere” (D) instead when documentation specifies the resection was confined to one hemisphere. |
| 5 | Approach | 0 | Open — cutting through skin, soft tissue, and the bone flap to directly visualize the brain, consistent with the craniotomy technique. |
| 6 | Device | Z | No Device — no device remains as a functional part of the excision itself. |
| 7 | Qualifier | Z | No Qualifier — a standard excision without an additional qualifying characteristic. |
Root Operation Comparison
- Excision (B) removes only a portion of the body part — appropriate for tumor resection where surrounding brain tissue is preserved, which is the correct root operation for 61510-driven procedures.
- Resection (T) would apply only if an entire body part were removed, which is not anatomically or clinically applicable to a tumor excision within the brain.
- Drainage (9) would instead apply to a hematoma evacuation procedure (e.g., PCS equivalents of CPT 61312/61313), not to solid tumor excision — don’t conflate the two when abstracting combined operative sessions.
📝 Coding Examples
Example 1
Clinical Scenario: A 58-year-old presents with new-onset seizures and a left frontal lobe mass on MRI. The neurosurgeon performs a left frontal craniotomy with microsurgical excision of the mass; frozen section during surgery confirms a non-meningioma glioma. The dura and bone flap are replaced at closure, and the patient tolerates the procedure without complication.
| Field | Code | Rationale |
|---|---|---|
| CPT | 61510 | Standard open craniotomy for excision of a confirmed non-meningioma supratentorial tumor. |
| PDx | C71.1 | Frontal lobe is specifically documented as the tumor site, supporting the more specific code over C71.9. |
Note
Confirm the seizure history is captured as a secondary diagnosis if it meets reporting criteria and was actively evaluated or treated during the stay — don’t let it substitute for the neoplasm as principal diagnosis when the admission was primarily for tumor resection.
Example 2
Clinical Scenario: A 64-year-old with known metastatic lung cancer develops a solitary enhancing parietal lesion causing progressive weakness. The patient undergoes a right parietal craniotomy with excision of the metastatic lesion using intraoperative neuronavigation; pathology confirms metastatic adenocarcinoma consistent with the known primary.
| Field | Code | Rationale |
|---|---|---|
| CPT 1 | 61510 | Base procedure for excision of the supratentorial metastatic lesion. |
| CPT 2 | 61781 | Add-on code for stereotactic computer-assisted navigation, separately reportable when neuronavigation is used and documented as medically necessary. |
| PDx | C79.31 | Secondary malignant neoplasm of brain, reflecting the metastatic (not primary) nature of the lesion. |
Warning
Do not default to reporting the navigation add-on code just because equipment was available in the OR — the operative note must independently document that navigation guided a specific step of the resection, or auditors may recoup the add-on payment.
Example 3
Clinical Scenario: Six weeks after an initial 61510 procedure for a temporal lobe glioma, the same patient returns for a planned second-stage resection of residual tumor identified on postoperative imaging, as documented in the original operative plan.
| Field | Code | Rationale |
|---|---|---|
| CPT | 61510--58 | Modifier -58 indicates a staged, related procedure performed within the original global period, avoiding an incorrect denial as a duplicate or unrelated service. |
| PDx | C71.2 | Temporal lobe glioma remains the principal diagnosis driving the staged resection. |
Global period reminder, if applicable
Because the second resection falls within the original 90-day global period, failing to append -58 will likely trigger a global-period denial rather than separate payment.
⚠️ Common Coding Pitfalls
- Pitfall 1: Defaulting to CPT 61510 before pathology confirms the tumor is not a meningioma. If final pathology shows meningioma, the correct code is 61512, not 61510 — hold inpatient coding until pathology is finalized whenever the pre-op differential includes meningioma.
- Pitfall 2: Appending -RT, -LT, or -50 to 61510. The brain is not billed as a paired/bilateral structure for this code family, and these modifiers will typically trigger a payer edit or rejection.
- Pitfall 3: Failing to append -58, -78, or -79 for a related or unrelated procedure performed within the 90-day global period, resulting in inappropriate bundling denials for legitimately separate services.
- Pitfall 4: Reporting add-on codes like stereotactic navigation or intraoperative neurophysiologic monitoring without operative-note documentation that independently supports their medical necessity and use during the case.
- Pitfall 5: Assigning C71.9 (unspecified brain site) when the operative or pathology report clearly documents the specific lobe — this understates specificity and can affect both HCC capture and MS-DRG assignment.
- Pitfall 6: Confusing 61510 (supratentorial) with 61518 (infratentorial/posterior fossa) based on surgical approach rather than actual tumor location relative to the tentorium cerebelli — verify location against the radiology and operative report, not assumption.
📎 Sources
1. American Medical Association. *CPT 2026 Professional Edition.* AMA; 2026. 2. Centers for Medicare & Medicaid Services. *PFS Relative Value Files, RVU26A/RVU26B National Physician Fee Schedule Relative Value File.* CMS.gov; 2026. 3. Centers for Medicare & Medicaid Services. *MS-DRG Definitions Manual, Version 43.0 — MDC 1.* CMS.gov; 2026. 4. Noridian Healthcare Solutions. *Local Coverage Determination (LCD) Search — Jurisdictions JE/JF.* Noridian; 2026.Sources listed above correspond to superscript citations throughout this note. Verify all Medicare payment figures against your current CMS PFS Lookup tool and applicable MAC LCD prior to claim submission. Please use the latest AAPC/AHIMA Coding Books to verify each code within this note.