CPT code 61586: Skull-base resection, nasopharynx involvement2026 Medicare rate & RVUs in Texas

CMS doesn’t publish an office rate for 61586 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.

What 61586 covers

This code describes a major operation to remove a lesion involving both the nasopharynx and skull base. The surgeon’s work is directed at resection, rather than biopsy alone. Cases may involve an otolaryngologist or head-and-neck surgeon working with a neurosurgeon, particularly when the lesion extends toward the cranial base. A nasopharyngeal tumor with skull-base extension, such as a juvenile nasopharyngeal angiofibroma, is a representative clinical situation. These operations are generally performed in a hospital operating room.

Select the code when the operative report supports removal of the lesion at the nasopharynx-skull-base site; document the extent, structures addressed, and resection performed. The 90-day global period includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. 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. An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation, and team surgery is 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 61586 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

How the 61586 rate is calculated

Each of 61586’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.

Payment rules and modifiers for 61586

61586 has a 90-day global period: related visits in that window are included in the surgery payment.

What modifiers do to the payment

When to use modifier 51

61586 compared with similar codes

How to choose

61575Transoral skull-base surgeryStandard transoral exposure

This code concerns resection involving the nasopharynx and skull base. Code 61575 describes a transoral route to the skull base, brainstem, or upper spinal cord.

61580Craniofacial approachExtradural anterior fossa

Code 61580 describes craniofacial access to the anterior cranial fossa. Choose based on the operation and route documented, rather than treating the codes as interchangeable.

61590Skull base approachInfratemporal, extradural

Code 61590 describes an infratemporal approach. This code identifies resection involving the nasopharynx and skull base, so the operative target and route help distinguish them.

Codes related to 61586

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

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

Open CMS sourceHow we calculate rates