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Billing code 61686: Brain AVM surgeryMedicare rate & RVUs

Reports open intracranial surgery for a complex arteriovenous malformation located above the tentorium, typically performed by a neurosurgeon.

CMS RVU26DEffective Oct 1, 2026109 payment localities65 Medicare services in 2024

Medicare pays $4,248.59 for 61686 nationally in a facility.

Medicare rate · 61686

Brain AVM surgery

Swap in your local Medicare rate.

Work RVUs
65.81
Total RVUs
127.20
Global days
090

National rate · 2026

$4,248.59

Facility setting, before claim adjustments.

See every locality for 61686 → · 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 61686 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 61686 covers

This code describes open surgery to treat a complex arteriovenous malformation (AVM) in the supratentorial part of the brain, such as the cerebral hemispheres. A neurosurgeon typically performs the operation through an intracranial approach, often in a hospital operating room. The surgeon works to remove or otherwise surgically treat the abnormal vessel connection; this is distinct from catheter-based embolization.

Choose this code when the operative documentation supports both the supratentorial location and the complex classification. The record should describe the AVM, its location, the operative approach, and the work performed. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard multiple-procedure reduction. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation. Team surgery is not permitted, and modifier 50 is inappropriate for this code.

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 61686 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

61686 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$3,705.57
Alaska*Unavailable$5,004.00
ArizonaUnavailable$4,080.18
ArkansasUnavailable$3,640.29
AtlantaUnavailable$4,459.65
AustinUnavailable$4,212.32
BakersfieldUnavailable$4,035.33
Baltimore/Surr. CntysUnavailable$4,585.62
BeaumontUnavailable$4,081.68
BrazoriaUnavailable$4,051.94

61686 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
61686 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 61686 rate is calculated

Each of 61686’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 · 61686

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 65.81Practice expense 33.61Malpractice 27.78

127.2000 adjusted RVUs×$33.4009 conversion factor=$4,248.59

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

Payment rules and modifiers for 61686

61686 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 61686

Brain AVM surgery

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)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
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 · 61686

Brain AVM surgery

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 51 · payment effect

With and without the modifier

61686 without 51 · national facility

$4,248.59

Brain AVM surgery

61686-51 · Second procedure: 50%

$2,124.30

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

61686 compared with similar codes

Compare codes

61686 vs 61684 vs 61692 vs 61624: national Medicare rates

Swap in your local Medicare rate.

  • 61686
    Brain AVM surgery · 65.81 wRVU
    —
  • 61684
    Dural AVM surgery · 40.6 wRVU
    —
  • 61692
    Aneurysm surgery · 53.23 wRVU
    —
  • 61624
    CNS embolization · 19.5 wRVU
    —

How to choose

61684Dural AVM surgery
Both are for supratentorial AVM surgery; 61684 represents the simple classification, while 61686 represents the complex classification.
61692Aneurysm surgery
Both represent complex AVM surgery, but 61692 is for an infratentorial lesion; 61686 is for a supratentorial lesion.
61624CNS embolization
61624 describes catheter-based permanent occlusion or embolization in the central nervous system. This code describes open intracranial surgery for a complex supratentorial AVM.

Codes related to 61686

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

Codes related to 61686
CodeHow it relatesNational office range
Same family
61684Dural AVM surgerySupratentorial AVM surgery with the simple classification.No office rate
61690Aneurysm surgeryInfratentorial AVM surgery with the simple classification.No office rate
61692Aneurysm surgeryInfratentorial AVM surgery with the complex classification.No office rate
Used instead
61624CNS embolizationCatheter-based permanent occlusion or embolization in the central nervous system.No office rate

61686 billing questions

How is this code different from 61684?

Both describe surgery for a supratentorial intracranial AVM. Use 61686 for the complex classification and 61684 for the simple classification, as supported by the operative documentation.

When would 61690 or 61692 be more appropriate?

Those codes describe surgery for an infratentorial AVM. This code is for a complex AVM located supratentorially.

Is catheter-based AVM embolization reported with this code?

No. This code describes open intracranial surgery; code 61624 describes catheter-based permanent occlusion or embolization in the central nervous system.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation, and team surgery is not permitted under the CMS facts for this code.

Should modifier 50 be used for AVMs on both sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; modifier 50 should not be used.

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 61686PPRRVU2026_Oct_nonQPP.csv, line 6,861 (RVU26D)

Open CMS sourceHow we calculate rates

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