CPT code 61108: Subdural drainage, twist-drill approach2026 Medicare rate & RVUs in Texas
Reports twist-drill cranial access to evacuate or drain a subdural hematoma, typically when a neurosurgeon treats a symptomatic subdural collection.
CMS doesn’t publish an office rate for 61108 in Texas.
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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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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $935.21 |
| Beaumont, TX | Unavailable | $882.31 |
| Brazoria, TX | Unavailable | $894.69 |
| Dallas, TX | Unavailable | $908.98 |
| Fort Worth, TX | Unavailable | $907.00 |
| Galveston, TX | Unavailable | $902.82 |
| Houston, TX | Unavailable | $986.65 |
| Rest of Texas | Unavailable | $893.80 |
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
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
| 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) | 1 | Not paid (statutory restriction). |
| 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 · 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.
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%).
61108 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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