FeeBase
Log inGet started
Menu

Billing code 61105: Twist-drill punctureMedicare rate & RVUs

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 RVU26DEffective Oct 1, 2026109 payment localities52 Medicare services in 2024

Medicare pays $498.34 for 61105 nationally in a facility.

Medicare rate · 61105

Twist-drill puncture

Work RVUs
5.31
Total RVUs
14.92
Global days
090

National rate · 2026

$498.34

Facility setting, before claim adjustments.

See every locality for 61105 →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.

On this page 10 sections
  1. Medicare rate
  2. What 61105 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 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

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

109 of 109 payment localities

61105 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$435.20
Alaska*Unavailable$569.60
ArizonaUnavailable$479.97
ArkansasUnavailable$427.46
AtlantaUnavailable$517.79
AustinUnavailable$504.50
BakersfieldUnavailable$496.25
Baltimore/Surr. CntysUnavailable$536.83
BeaumontUnavailable$470.87
BrazoriaUnavailable$481.16

61105 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

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
61105 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 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

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)0Not paid without supporting documentation.
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 · 61105

Twist-drill puncture

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

61105 without 51 · national facility

$498.34

Twist-drill puncture

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%).

When to use modifier 51

61105 compared with similar codes

Compare codes · National

5 codes, side by side

  • 61105

    Twist-drill puncture5.31 wRVU

    Not priced

  • 61108

    Subdural drainage11.35 wRVU

    Not priced

  • 61107

    Ventricular catheter4.87 wRVU

    Not priced

  • 61120

    Ventricular puncture9.36 wRVU

    Not priced

  • 61154

    Hematoma drainage16.64 wRVU

    Not priced

How to choose

61108Subdural drainage
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 catheter
61107 is for twist-drill placement of a ventricular catheter or pressure-recording device; 61105 is for puncture to drain a hematoma.
61120Ventricular puncture
61120 uses a burr hole for ventricular puncture. This code describes puncture through twist-drill access.
61154Hematoma drainage
61154 uses a burr hole for hematoma evacuation or drainage. This code is selected for the documented twist-drill puncture approach.

Codes related to 61105

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

Codes related to 61105
CodeHow it relatesNational office range
Used instead
61108Subdural drainageTwist-drill evacuation or drainage specifically for a subdural hematoma.No office rate
61107Ventricular catheterTwist-drill access for ventricular catheter or pressure-device implantation.No office rate
61120Ventricular punctureBurr-hole approach for ventricular puncture rather than twist-drill access.No office rate
61154Hematoma drainageBurr-hole evacuation or drainage of a hematoma.No office rate

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

Show the CMS file lines behind this rate
RVUs for 61105PPRRVU2026_Oct_nonQPP.csv, line 6,743 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 61105 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets

Put 61105 and the rest of your codes on one sheet

Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.

Build my fee sheetOr price your code list free →