Billing code 61686: Brain AVM surgeryMedicare rate & RVUs in Utah
Reports open intracranial surgery for a complex arteriovenous malformation located above the tentorium, typically performed by a neurosurgeon.
CMS doesn’t publish an office rate for 61686 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 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.
61686 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $4,086.59 |
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
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
| 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) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not 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 · 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.
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%).
61686 compared with similar codes
Compare codes
61686 vs 61684 vs 61692 vs 61624: national Medicare rates
Swap in your local Medicare rate.
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.
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
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