No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
61105 Twist-drill puncture Medicare reimbursement rates in Alaska
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. Compare 61105 office and facility rates across CMS payment localities in Alaska.
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 61105 in Alaska?
Alaska has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$569.60
1 of 1 localities have a supported rate.
Payment area: Alaska*
One mapped payment locality.
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.
Neurosurgery
About 61105: Twist-drill hematoma drainage puncture
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.
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.
CMS billing rules for 61105
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU5.31 · 36%
- Practice expense (office) RVU7.38 · 49%
- Malpractice RVU2.23 · 15%
52
Medicare services in 2024 · #5335 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.
61105 compared with similar codes
Office rates for Alaska, from the same CMS release.
No office rate
61107 is for twist-drill placement of a ventricular catheter or pressure-recording device; 61105 is for puncture to drain a hematoma.
No office rate
61120 uses a burr hole for ventricular puncture. This code describes puncture through twist-drill access.
No office rate
61154 uses a burr hole for hematoma evacuation or drainage. This code is selected for the documented twist-drill puncture approach.
Compare 61105 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.
1 of 1 payment localities
Alaska* →
Office / nonfacility
Unavailable
Facility
$569.60
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 61105 in Alaska*.
PPRRVU2026_Oct_nonQPP.csv
6,743
- Code
- 61105
- Physician work
- 5.31
- Practice expense
- 7.38
- Malpractice
- 2.23
GPCI2026.csv
5
- Locality
- Alaska*
- Physician work
- 1.500
- Practice expense
- 1.065
- Malpractice
- 0.551
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.31 | × 1.500 | 7.9650 |
| Practice expense | 7.38 | × 1.065 | 7.8597 |
| Malpractice | 2.23 | × 0.551 | 1.2287 |
| Total RVUs | 17.0534 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alaska*$569.60
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 5.31 | 1.5 |
| Practice expense | 7.38 | 1.065 |
| Malpractice | 2.23 | 0.551 |
(5.31 × 1.5 + 7.38 × 1.065 + 2.23 × 0.551) × $33.4009 = $569.60
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 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.
6,74061050,,Remove brain canal fluid,A,,1.47,0.46,NA,0.46,,0.14,2.07,2.07,0,000,0.00,0.00,0.00,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,74161055,,Injection into brain canal,A,,2.05,0.64,NA,0.64,,0.26,2.95,2.95,0,000,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,74261070,,Brain canal shunt procedure,A,,0.87,0.52,NA,0.52,,0.15,1.54,1.54,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,74361105,,Tdh sdrl/ventr pnxr,A,,5.31,7.38,NA,7.38,,2.23,14.92,14.92,0,090,0.11,0.76,0.13,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,74461107,,Tdh pnxr implt ventr cath,A,,4.87,1.70,NA,1.70,,2.04,8.61,8.61,0,000,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,74561108,,Tdh pnxr evac&/drg sdrl hmta,A,,11.35,11.88,NA,11.88,,4.58,27.81,27.81,0,090,0.11,0.76,0.13,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,7466110F,,Counsel prov driving risks,I,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609