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CPT code 61108: Subdural drainage, twist-drill approach2026 Medicare rate & RVUs

Reports twist-drill cranial access to evacuate or drain a subdural hematoma, typically when a neurosurgeon treats a symptomatic subdural collection.

CMS RVU26DEffective Oct 1, 2026109 payment localities352 Medicare services in 2024

Medicare pays $928.88 for 61108 nationally in a facility.

Medicare rate · 61108

Subdural drainage, twist-drill approach

Office or facility?

Work RVUs
11.35
Total RVUs
27.81
Global days
090

National rate · 2026

$928.88

Facility setting, before claim adjustments.

See every locality for 61108 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 61108 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 61108 covers

A neurosurgeon uses a twist drill to create a small opening in the skull and evacuates or drains a subdural hematoma. The service is commonly performed in a hospital operating room or other hospital setting for a patient whose subdural collection requires procedural treatment. The operative report should identify the hematoma and document the twist-drill approach and evacuation or drainage performed.

Choose this code for subdural hematoma treatment using twist-drill access, rather than a burr-hole approach or a procedure whose defining purpose is puncture or catheter placement. This major surgery has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service; 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 61108 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

61108 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$812.89
AlaskaUnavailable$1,075.54
ArizonaUnavailable$894.55
ArkansasUnavailable$798.74
Atlanta, GAUnavailable$967.11
Austin, TXUnavailable$935.21
Bakersfield, CAUnavailable$914.36
Baltimore area, MDUnavailable$1,000.17
Beaumont, TXUnavailable$882.31
Brazoria, TXUnavailable$894.69

61108 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
61108 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 61108 rate is calculated

Each of 61108’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 · 61108

RVUs × geographic indexes × conversion factor

Office or facility?

Work11.35

11.35 RVUs× 1.000 GPCI

Practice expense11.88

11.88 RVUs× 1.000 GPCI

Malpractice4.58

4.58 RVUs× 1.000 GPCI

Adjusted RVUs

27.8100

Conversion factor

$33.4009

Medicare rate

$928.88

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 61108

61108 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 61108

Subdural drainage, twist-drill approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.11/0.76/0.13Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 61108

Subdural drainage, twist-drill approach

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

61108 without 51 · national facility

$928.88

Subdural drainage, twist-drill approach

61108-51 · Second procedure: 50%

$464.44

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%).

When to use modifier 51

61108 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 61108

    Subdural drainage, twist-drill approach11.35 wRVU

    Not priced

  • 61154

    Hematoma drainage, extradural or subdural16.64 wRVU

    Not priced

  • 61105

    Twist-drill puncture, hematoma drainage5.31 wRVU

    Not priced

  • 61107

    Ventricular catheter, twist-drill access4.87 wRVU

    Not priced

How to choose

61154Hematoma drainageExtradural or subdural
Both can involve subdural hematoma treatment, but 61108 uses twist-drill access and 61154 uses a burr-hole approach.
61105Twist-drill punctureHematoma drainage
61105 is for twist-drill puncture for subdural or ventricular access; 61108 is for evacuating or draining a subdural hematoma.
61107Ventricular catheterTwist-drill access
61107 identifies twist-drill access with drainage-catheter insertion. Use 61108 when the service is subdural hematoma evacuation or drainage.

Codes related to 61108

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 61108
CodeHow it relatesNational office range
Used instead
61154Hematoma drainage, extradural or subduralBurr-hole approach for evacuation or drainage of an extradural or subdural hematoma.No office rate
61105Twist-drill puncture, hematoma drainageTwist-drill puncture for subdural or ventricular access rather than hematoma evacuation.No office rate
61107Ventricular catheter, twist-drill accessTwist-drill access with insertion of a subdural or ventricular drainage catheter.No office rate

61108 billing questions

How is 61108 distinguished from 61154?

61108 describes subdural hematoma treatment through a twist-drill opening. Code 61154 describes evacuation or drainage using a burr-hole approach.

When would 61105 or 61107 be a better fit?

Those codes describe twist-drill puncture services for subdural or ventricular access. Code 61107 specifically identifies insertion of a drainage catheter; 61108 is selected for evacuation or drainage of a subdural hematoma.

Can modifier 50 be used for bilateral treatment?

No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant surgeon or co-surgeon be reported?

Medicare does not pay an assistant at surgery for this service. Co-surgeons and team surgery are not permitted.

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

Show the CMS file lines behind this rate
RVUs for 61108PPRRVU2026_Oct_nonQPP.csv, line 6,745 (RVU26D)

Open CMS sourceHow we calculate rates

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