CPT code 61618: Dural leak repair, cranial approach2026 Medicare rate & RVUs in Missouri
Cranial approach repair of a dural or cerebrospinal fluid leak unrelated to prior skull-base surgery, typically performed by a neurosurgeon.
CMS doesn’t publish an office rate for 61618 in Missouri.
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
On this page 9 sections
What 61618 covers
This service repairs a dural defect causing cerebrospinal fluid leakage through a cranial approach, commonly requiring surgical exposure such as a craniotomy. A neurosurgeon or skull-base surgeon may perform it in a hospital operating room for a leak that is not a consequence of skull-base surgery. The operative report should establish the leak, the cranial approach, and the repair performed.
Select this code based on the cranial route and the circumstances of the leak, not simply because the dura was closed during another operation. The related approach-specific sibling is 61619. CMS assigns a 90-day global period, which includes the day-before preoperative visit and related postoperative care during that period. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% 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 61618 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $1,188.98 |
| Metropolitan St. Louis, MO | Unavailable | $1,199.34 |
| Rest of Missouri | Unavailable | $1,157.04 |
How the 61618 rate is calculated
Each of 61618’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 · 61618
RVUs × geographic indexes × conversion factor
Work18.22
18.22 RVUs× 1.000 GPCI
Practice expense12.18
12.18 RVUs× 1.000 GPCI
Malpractice6.08
6.08 RVUs× 1.000 GPCI
Adjusted RVUs
36.4800
Conversion factor
$33.4009
Medicare rate
$1,218.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 61618
61618 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 61618
Dural leak repair, cranial 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) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 2 | 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 · 61618
Dural leak repair, cranial 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
61618 without 51 · national facility
$1,218.46
Dural leak repair, cranial approach
61618-51 · Second procedure: 50%
$609.23
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%).
61618 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 61619Dural repairSkull base leak
- Use 61618 for the cranial route. Use 61619 when the documented repair follows an extracranial, intradural approach.
- 61600Skull base resectionAnterior fossa, extradural
- 61600 describes resection or excision of a cranial lesion, rather than repair of a dural or cerebrospinal fluid leak.
- 61605Skull-base resectionMiddle fossa, extradural
- 61605 describes resection or excision of a skull-base lesion. Choose 61618 when the service is repair of a qualifying leak, not lesion removal.
61618 billing questions
How does 61618 differ from 61619?
The distinction is the surgical route: 61618 is for a cranial approach, while 61619 describes an extracranial, intradural approach. The operative report should support the route used.
Can this code describe a leak after skull-base surgery?
No. This code is for a dural or cerebrospinal fluid leak that is not following skull-base surgery. Do not select it solely because the repair used a cranial approach.
What documentation supports reporting 61618?
Document the leak or dural defect, the cranial approach, and the repair performed. The report should make clear that the leak was not following skull-base surgery.
How does the 90-day global period affect postoperative visits?
The day-before preoperative visit and related postoperative care for 90 days are included in the global period. The code is classified as major surgery.
How are other procedures in the same session paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation.
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
Fee sheets · Coming soon
Put 61618 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist