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Billing code 61581: Craniofacial approachMedicare rate & RVUs

Reports a craniofacial surgical route to the anterior cranial fossa when a lesion requires access through the cranial and facial regions.

CMS RVU26DEffective Oct 1, 2026109 payment localities54 Medicare services in 2024

Medicare pays $2,359.77 for 61581 nationally in a facility.

Medicare rate · 61581

Craniofacial approach

Swap in your local Medicare rate.

Work RVUs
38.15
Total RVUs
70.65
Global days
090

National rate · 2026

$2,359.77

Facility setting, before claim adjustments.

See every locality for 61581 → · 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 61581 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 61581 covers

This code describes a craniofacial route for reaching the anterior cranial fossa, where a lesion may involve the skull base near the nasal cavity or paranasal sinuses. The operation combines cranial and facial exposure; a neurosurgeon may work with an otolaryngologist or another surgeon experienced in skull base surgery. It is generally performed in a hospital operating room for complex skull base disease, rather than as an office procedure.

Select the code from the operative report’s documented approach and the specific work performed, not simply the diagnosis or lesion location. The record should identify the cranial and facial exposure and the target area. Medicare assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 results in payment at 150% for a bilateral procedure. Co-surgeons and team surgery are permitted; assistant-at-surgery services are subject to a statutory payment restriction.

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 61581 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

61581 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$2,166.60
Alaska*Unavailable$2,971.83
ArizonaUnavailable$2,305.10
ArkansasUnavailable$2,142.72
AtlantaUnavailable$2,415.38
AustinUnavailable$2,393.28
BakersfieldUnavailable$2,397.59
Baltimore/Surr. CntysUnavailable$2,489.92
BeaumontUnavailable$2,265.61
BrazoriaUnavailable$2,320.94

61581 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
61581 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 61581 rate is calculated

Each of 61581’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 · 61581

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 38.15Practice expense 26.93Malpractice 5.57

70.6500 adjusted RVUs×$33.4009 conversion factor=$2,359.77

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 61581

61581 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 61581

Craniofacial 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)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)2Permitted.
Team surgery (66)2Permitted.
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 · 61581

Craniofacial 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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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 50 · payment effect

With and without the modifier

61581 without 50 · national facility

$2,359.77

Craniofacial approach

61581-50 · Bilateral: 150%

$3,539.66

Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).

When to use modifier 50

61581 compared with similar codes

Compare codes

61581 vs 61584 vs 61590 vs 61580: national Medicare rates

Swap in your local Medicare rate.

  • 61581
    Craniofacial approach · 38.15 wRVU
    —
  • 61584
    Skull base approach · 36.76 wRVU
    —
  • 61590
    Skull base approach · 45.86 wRVU
    —
  • 61580
    Craniofacial approach · 33.65 wRVU
    —

How to choose

61584Skull base approach
Use 61584 when the documented route is orbitocranial. This code is for the craniofacial approach to the anterior cranial fossa.
61590Skull base approach
61590 describes an infratemporal approach. Choose this code when the operative report documents a craniofacial route to the anterior cranial fossa.
61580Craniofacial approach
61580 is a neighboring craniofacial approach code. Distinguish it from 61581 by the specific approach variant documented in the operative report.

Codes related to 61581

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

Codes related to 61581
CodeHow it relatesNational office range
Same family
61580Craniofacial approachA neighboring craniofacial anterior cranial fossa approach code; distinguish by the specific operative approach.No office rate
61582Craniofacial approachAnother craniofacial anterior cranial fossa approach variant in the same code family.No office rate
61583Craniofacial approachA related craniofacial approach variant; select based on the documented operative work.No office rate
Used instead
61584Skull base approachDescribes an orbitocranial route rather than the craniofacial approach represented here.No office rate
61590Skull base approachDescribes an infratemporal route for skull base access.No office rate

61581 billing questions

How is this different from an orbitocranial approach?

This code identifies a craniofacial route to the anterior cranial fossa. Codes 61584, 61585, and 61592 identify orbitocranial approaches; select according to the approach documented in the operative report.

What documentation supports reporting this approach?

The operative report should describe the cranial and facial exposure and identify the anterior cranial fossa target. The diagnosis alone does not establish which approach code applies.

Can co-surgeons report this service?

CMS permits co-surgeons for this code. The record should support each surgeon’s distinct role in the operation.

Can an assistant-at-surgery be paid for this code?

CMS lists a statutory restriction on assistant-at-surgery payment for this service.

How are other same-session procedures paid?

Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and other procedures in the same session are paid at 50%. Related postoperative care is included in the 90-day global period.

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 61581PPRRVU2026_Oct_nonQPP.csv, line 6,822 (RVU26D)

Open CMS sourceHow we calculate rates

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