No office rate
61595 represents a transtemporal approach to the posterior cranial fossa. Use 61596 when the operative route is transcochlear and includes its distinct exposure work.
On this page
CMS RVU26D · Effective 2026-10-01
61596 Skull base approach Medicare reimbursement rates
Reports transcochlear surgical access to the posterior cranial fossa, including the extensive ear and temporal-bone work needed for skull base lesion surgery. Compare 61596 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 61596?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 61596 pays more and less
Skull base surgery
About 61596: Transcochlear posterior fossa approach
Reports transcochlear surgical access to the posterior cranial fossa, including the extensive ear and temporal-bone work needed for skull base lesion surgery.
This approach reaches the posterior cranial fossa through the temporal bone and cochlear region. The exposure includes mastoid work, removal of petrous bone, and posterior transposition of the facial nerve. It is used by skull base teams, typically involving an otologist or neurotologist and a neurosurgeon, to access lesions near the clivus, petrous apex, or ventral brainstem. The route is selected when the required exposure calls for this specific transcochlear corridor rather than a transtemporal or transpetrosal route.
Report the approach based on the operative route and documented work, not just the lesion’s location. The approach includes its described exposure steps; document the facial nerve transposition and bony work performed. Report the definitive lesion procedure separately when supported by the applicable CPT instructions. CMS classifies this as major surgery with a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures are performed in one session, the highest-valued is paid in full and others at 50%. For a bilateral procedure reported with modifier 50, CMS pays at 150%. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is permitted.
CMS billing rules for 61596
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery permitted.
Where the value comes from
- Work RVU38.44 · 61%
- Practice expense (office) RVU18.52 · 30%
- Malpractice RVU5.60 · 9%
80
Medicare services in 2024 · #5053 by national volume
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.
61596 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
61597 uses a transcondylar route, typically involving access around the occipital condyle. It is not the transcochlear temporal-bone approach described by 61596.
No office rate
61598 represents a transpetrosal route. Choose between it and 61596 based on the approach actually performed and documented, not merely the target lesion.
No office rate
61616 describes resection of an intradural posterior cranial fossa lesion; 61596 describes the transcochlear approach. The codes represent different parts of the operative service.
See how rates vary across the country
61596 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 61596 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1931.06 |
| Alaska* | Office Unavailable | Facility $2687.75 |
| Arizona | Office Unavailable | Facility $2043.45 |
| Arkansas | Office Unavailable | Facility $1911.62 |
| Atlanta | Office Unavailable | Facility $2140.91 |
| Austin | Office Unavailable | Facility $2106.68 |
| Bakersfield | Office Unavailable | Facility $2100.20 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $2199.59 |
| Beaumont | Office Unavailable | Facility $2020.61 |
| Brazoria | Office Unavailable | Facility $2053.11 |
| Chicago | Office Unavailable | Facility $2343.86 |
| Chico | Office Unavailable | Facility $2083.98 |
| Colorado | Office Unavailable | Facility $2103.59 |
| Connecticut | Office Unavailable | Facility $2202.15 |
| Dallas | Office Unavailable | Facility $2072.08 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $2290.14 |
| Delaware | Office Unavailable | Facility $2069.67 |
| Detroit | Office Unavailable | Facility $2196.22 |
| East St. Louis | Office Unavailable | Facility $2229.74 |
| El Centro | Office Unavailable | Facility $2084.92 |
| Fort Lauderdale | Office Unavailable | Facility $2248.73 |
| Fort Worth | Office Unavailable | Facility $2068.33 |
| Fresno | Office Unavailable | Facility $2083.98 |
| Galveston | Office Unavailable | Facility $2063.33 |
| Hanford-Corcoran | Office Unavailable | Facility $2083.98 |
| Hawaii, Guam | Office Unavailable | Facility $2095.56 |
| Houston | Office Unavailable | Facility $2165.83 |
| Idaho | Office Unavailable | Facility $1941.50 |
| Indiana | Office Unavailable | Facility $1948.26 |
| Iowa | Office Unavailable | Facility $1924.19 |
| Kansas | Office Unavailable | Facility $1937.40 |
| Kentucky | Office Unavailable | Facility $2005.00 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $2192.56 |
| Madera | Office Unavailable | Facility $2083.98 |
| Manhattan | Office Unavailable | Facility $2381.55 |
| Merced | Office Unavailable | Facility $2083.98 |
| Metropolitan Boston | Office Unavailable | Facility $2241.63 |
| Metropolitan Kansas City | Office Unavailable | Facility $2047.52 |
| Metropolitan Philadelphia | Office Unavailable | Facility $2174.13 |
| Metropolitan St. Louis | Office Unavailable | Facility $2060.24 |
| Miami | Office Unavailable | Facility $2400.91 |
| Minnesota | Office Unavailable | Facility $1975.82 |
| Mississippi | Office Unavailable | Facility $1954.76 |
| Modesto | Office Unavailable | Facility $2083.98 |
| Montana** | Office Unavailable | Facility $2089.19 |
| Napa | Office Unavailable | Facility $2275.13 |
| Nebraska | Office Unavailable | Facility $1925.59 |
| Nevada** | Office Unavailable | Facility $2058.94 |
| New Hampshire | Office Unavailable | Facility $2091.54 |
| New Mexico | Office Unavailable | Facility $2075.81 |
| New Orleans | Office Unavailable | Facility $2078.50 |
| North Carolina | Office Unavailable | Facility $1980.59 |
| North Dakota** | Office Unavailable | Facility $1978.46 |
| Northern Nj | Office Unavailable | Facility $2282.14 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $2448.94 |
| Ohio | Office Unavailable | Facility $2037.24 |
| Oklahoma | Office Unavailable | Facility $1981.66 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $2167.58 |
| Portland | Office Unavailable | Facility $2130.88 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $2245.38 |
| Puerto Rico | Office Unavailable | Facility $2093.56 |
| Queens | Office Unavailable | Facility $2366.99 |
| Redding | Office Unavailable | Facility $2083.98 |
| Rest Of California | Office Unavailable | Facility $2083.98 |
| Rest Of Florida | Office Unavailable | Facility $2156.43 |
| Rest Of Georgia | Office Unavailable | Facility $2058.67 |
| Rest Of Illinois | Office Unavailable | Facility $2141.05 |
| Rest Of Louisiana | Office Unavailable | Facility $2010.57 |
| Rest Of Maine | Office Unavailable | Facility $1969.37 |
| Rest Of Maryland | Office Unavailable | Facility $2094.48 |
| Rest Of Massachusetts | Office Unavailable | Facility $2104.92 |
| Rest Of Michigan | Office Unavailable | Facility $2059.87 |
| Rest Of Missouri | Office Unavailable | Facility $1999.33 |
| Rest Of New Jersey | Office Unavailable | Facility $2215.97 |
| Rest Of New York | Office Unavailable | Facility $2003.08 |
| Rest Of Oregon | Office Unavailable | Facility $2031.53 |
| Rest Of Pennsylvania | Office Unavailable | Facility $2028.55 |
| Rest Of Texas | Office Unavailable | Facility $2039.87 |
| Rest Of Washington | Office Unavailable | Facility $2094.33 |
| Rhode Island | Office Unavailable | Facility $2114.17 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $2144.56 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $2149.82 |
| Salinas | Office Unavailable | Facility $2140.93 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $2163.65 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $2363.96 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $2357.60 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $2417.42 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $2391.42 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $2110.58 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $2162.73 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $2141.41 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $2182.33 |
| Seattle (King Cnty) | Office Unavailable | Facility $2259.95 |
| South Carolina | Office Unavailable | Facility $2014.49 |
| South Dakota** | Office Unavailable | Facility $1965.36 |
| Southern Maine | Office Unavailable | Facility $2014.97 |
| Stockton | Office Unavailable | Facility $2083.98 |
| Suburban Chicago | Office Unavailable | Facility $2259.65 |
| Tennessee | Office Unavailable | Facility $1946.67 |
| Utah | Office Unavailable | Facility $2033.37 |
| Vallejo | Office Unavailable | Facility $2265.97 |
| Vermont | Office Unavailable | Facility $1990.97 |
| Virgin Islands | Office Unavailable | Facility $2093.56 |
| Virginia | Office Unavailable | Facility $2024.05 |
| Visalia | Office Unavailable | Facility $2083.98 |
| West Virginia | Office Unavailable | Facility $2089.14 |
| Wisconsin | Office Unavailable | Facility $1934.14 |
| Wyoming** | Office Unavailable | Facility $2040.93 |
| Yuba City | Office Unavailable | Facility $2083.98 |
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61596 billing questions
How is this approach different from 61595?
61596 describes a transcochlear route with petrous bone removal and posterior facial nerve transposition. 61595 describes a transtemporal route; select the code matching the operative corridor and documented approach.
Does 61596 include the lesion removal?
The code describes the transcochlear approach and its exposure work. Report the definitive lesion procedure separately when the applicable CPT instructions support separate reporting.
Which parts of the exposure are included?
The approach includes the associated mastoid work, petrous apicectomy, and posterior transposition of the facial nerve described for this route. Do not separately report those steps as though they were independent procedures.
What documentation supports 61596?
The operative report should identify the transcochlear route and describe the mastoid and petrous bone work and facial nerve transposition. The documented approach, not simply the diagnosis or lesion site, supports code selection.
Can modifier 50 be used?
CMS lists this as a bilateral procedure; when the procedure is bilateral and reported with modifier 50, payment is at 150%. The operative documentation must support bilateral performance.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment. Co-surgeons are paid only when supporting documentation is provided; team surgery is also 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,82961591,,Infratemporal approach/skull,A,,45.84,26.12,NA,26.12,,11.25,83.21,83.21,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,83061592,,Orbitocranial approach/skull,A,,42.00,32.70,NA,32.70,,16.12,90.82,90.82,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,83161595,,Transtemporal approach/skull,A,,32.90,24.06,NA,24.06,,8.49,65.45,65.45,0,090,0.11,0.76,0.13,2,1,1,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,83261596,,Transcochlear approach/skull,A,,38.44,18.52,NA,18.52,,5.60,62.56,62.56,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,83361597,,Transcondylar approach/skull,A,,39.80,32.18,NA,32.18,,16.81,88.79,88.79,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,83461598,,Transpetrosal approach/skull,A,,35.62,34.60,NA,34.60,,15.04,85.26,85.26,0,090,0.11,0.76,0.13,2,0,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,83561600,,Resect/excise cranial lesion,A,,29.26,21.58,NA,21.58,,6.49,57.33,57.33,0,090,0.11,0.76,0.13,2,0,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00