CPT code 61105: Twist-drill puncture, hematoma drainage2026 Medicare rate & RVUs in California
Reports a twist-drill puncture into the subdural or ventricular space to drain a hematoma, rather than implanting a catheter or using a burr hole.
CMS doesn’t publish an office rate for 61105 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 61105 covers
A neurosurgeon makes a small opening through the skull with a twist drill to puncture the subdural or ventricular space and drain a hematoma. The service is typically performed in a hospital or other facility when hematoma drainage is needed through this limited access approach. The operative note should identify the puncture site, the hematoma being drained, and the work performed; the access and purpose help distinguish this service from catheter implantation or burr-hole procedures.
Select the code when the documented procedure is a twist-drill puncture for hematoma drainage, not simply because a twist drill was used. The day-before preoperative visit and 90 days of related postoperative care are included in the global period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documented medical necessity; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 61105 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $496.25 |
| Chico, CA | Unavailable | $490.46 |
| El Centro, CA | Unavailable | $490.83 |
| Fresno, CA | Unavailable | $490.46 |
| Hanford, CA | Unavailable | $490.46 |
| Los Angeles, CA | Unavailable | $525.70 |
| Madera, CA | Unavailable | $490.46 |
| Marin County, CA | Unavailable | $575.96 |
| Merced, CA | Unavailable | $490.46 |
| Modesto, CA | Unavailable | $490.46 |
| Napa, CA | Unavailable | $551.26 |
| Oxnard, CA | Unavailable | $520.09 |
| Redding, CA | Unavailable | $490.46 |
| Rest of California | Unavailable | $490.46 |
| Riverside, CA | Unavailable | $514.25 |
| Sacramento, CA | Unavailable | $510.35 |
| Salinas, CA | Unavailable | $508.47 |
| San Benito County, CA | Unavailable | $592.24 |
| San Diego, CA | Unavailable | $517.86 |
| San Francisco, CA | Unavailable | $573.43 |
| San Luis Obispo, CA | Unavailable | $501.06 |
| Santa Clara County, CA | Unavailable | $581.89 |
| Santa Cruz, CA | Unavailable | $520.50 |
| Santa Maria, CA | Unavailable | $509.67 |
| Santa Rosa, CA | Unavailable | $525.30 |
| Stockton, CA | Unavailable | $490.46 |
| Vallejo, CA | Unavailable | $547.61 |
| Visalia, CA | Unavailable | $490.46 |
| Yuba City, CA | Unavailable | $490.46 |
How the 61105 rate is calculated
Each of 61105’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 61105
RVUs × geographic indexes × conversion factor
Work5.31
5.31 RVUs× 1.000 GPCI
Practice expense7.38
7.38 RVUs× 1.000 GPCI
Malpractice2.23
2.23 RVUs× 1.000 GPCI
Adjusted RVUs
14.9200
Conversion factor
$33.4009
Medicare rate
$498.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 61105
61105 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 61105
Twist-drill puncture, hematoma drainage
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 61105
Twist-drill puncture, hematoma drainage
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
61105 without 51 · national facility
$498.34
Twist-drill puncture, hematoma drainage
61105-51 · Second procedure: 50%
$249.17
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
61105 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 61108Subdural drainageTwist-drill approach
- Choose 61108 for twist-drill evacuation and/or drainage of a subdural hematoma. Choose 61105 when the documented service is a subdural or ventricular puncture for hematoma drainage.
- 61107Ventricular catheterTwist-drill access
- 61107 is for twist-drill placement of a ventricular catheter or pressure-recording device; 61105 is for puncture to drain a hematoma.
- 61120Ventricular punctureBurr-hole access
- 61120 uses a burr hole for ventricular puncture. This code describes puncture through twist-drill access.
- 61154Hematoma drainageExtradural or subdural
- 61154 uses a burr hole for hematoma evacuation or drainage. This code is selected for the documented twist-drill puncture approach.
61105 billing questions
How does this differ from 61108?
61105 describes a subdural or ventricular puncture for hematoma drainage. 61108 is specific to twist-drill evacuation and/or drainage of a subdural hematoma; use the code matching the documented procedure.
When would 61107 be reported instead?
61107 describes twist-drill access to implant a ventricular catheter or pressure-recording device. This code is for a puncture performed to drain a hematoma.
Does the global period include postoperative care?
Yes. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be appended for bilateral work?
No. CMS identifies bilateral adjustment as inappropriate for this code.
When is an assistant at surgery payable?
Assistant-at-surgery payment is allowed only when documentation supports medical necessity. Co-surgeons and team surgery are not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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