Billing code 61590: Skull base approachMedicare rate & RVUs in Utah
Reports an extradural infratemporal route to the middle cranial fossa for complex skull base surgery requiring access through the temporal bone region.
CMS doesn’t publish an office rate for 61590 in Utah.
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 9 sections
What 61590 covers
This code represents an extradural infratemporal approach to the middle cranial fossa, used to reach lesions at the skull base through the temporal bone region. The operation may involve substantial bone work and exposure around the petrous temporal bone. Neurosurgeons and otolaryngologists with skull base expertise commonly perform this type of approach in a hospital operating room for complex skull base lesions when the infratemporal route is required.
Report the approach when the operative note supports an infratemporal route and an extradural surgical plane; distinguish it from an intradural approach or a different skull base corridor. Documentation should identify the target, route, extent of exposure and relevant bone work. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in the same session, the highest-valued is paid in full and other procedures are reduced to 50%. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is 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.
61590 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $2,584.82 |
How the 61590 rate is calculated
Each of 61590’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 · 61590
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 45.86Practice expense 24.78Malpractice 9.17
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 61590
61590 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 61590
Skull base approach
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 2 | Permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 61590
Skull base 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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
61590 without 50 · national facility
$2,665.73
Skull base approach
61590-50 · Bilateral: 150%
$3,998.60
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).
61590 compared with similar codes
Compare codes
61590 vs 61591 vs 61595 vs 61596 vs 61598: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 61591Skull-base approach
- Both describe an infratemporal route to the middle cranial fossa; 61590 is extradural, while 61591 is intradural.
- 61595Skull base approach
- 61595 uses a transtemporal corridor. Choose 61590 when the documented route is infratemporal and extradural.
- 61596Skull base approach
- 61596 identifies a transcochlear approach. It is distinct from the infratemporal extradural route represented by 61590.
- 61598Skull base approach
- 61598 represents a transpetrosal approach; 61590 is selected for the documented infratemporal extradural corridor.
61590 billing questions
How is 61590 distinguished from 61591?
61590 represents the extradural infratemporal approach to the middle cranial fossa. Use 61591 when the documented approach is intradural.
What documentation supports reporting 61590?
The operative report should establish the infratemporal route, extradural plane, target, extent of exposure and relevant bone work.
Does the 90-day global period include postoperative care?
Yes. It includes the day-before preoperative visit and 90 days of related postoperative care.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is permitted.
How is bilateral reporting handled?
For a bilateral procedure, modifier 50 is paid at 150%.
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
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