No office rate
Both describe an infratemporal route to the middle cranial fossa; 61590 is extradural, while 61591 is intradural.
On this page
CMS RVU26D · Effective 2026-10-01
61590 Skull base approach Medicare reimbursement rates in Vermont
Reports an extradural infratemporal route to the middle cranial fossa for complex skull base surgery requiring access through the temporal bone region. Compare 61590 office and facility rates across CMS payment localities in Vermont.
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 61590 in Vermont?
Vermont 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
$2506.14
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Skull base surgery
About 61590: Extradural infratemporal skull base approach
Reports an extradural infratemporal route to the middle cranial fossa for complex skull base surgery requiring access through the temporal bone region.
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.
CMS billing rules for 61590
- 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 RVU45.86 · 57%
- Practice expense (office) RVU24.78 · 31%
- Malpractice RVU9.17 · 11%
386
Medicare services in 2024 · #3766 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.
61590 compared with similar codes
Office rates for Vermont, from the same CMS release.
No office rate
61595 uses a transtemporal corridor. Choose 61590 when the documented route is infratemporal and extradural.
No office rate
61596 identifies a transcochlear approach. It is distinct from the infratemporal extradural route represented by 61590.
No office rate
61598 represents a transpetrosal approach; 61590 is selected for the documented infratemporal extradural corridor.
Compare 61590 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
Vermont →
Office / nonfacility
Unavailable
Facility
$2506.14
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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 61590 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
6,828
- Code
- 61590
- Physician work
- 45.86
- Practice expense
- 24.78
- Malpractice
- 9.17
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 45.86 | × 1.000 | 45.8600 |
| Practice expense | 24.78 | × 0.990 | 24.5322 |
| Malpractice | 9.17 | × 0.506 | 4.6400 |
| Total RVUs | 75.0322 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Vermont$2506.14
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 45.86 | 1 |
| Practice expense | 24.78 | 0.99 |
| Malpractice | 9.17 | 0.506 |
(45.86 × 1 + 24.78 × 0.99 + 9.17 × 0.506) × $33.4009 = $2506.14
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.
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 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.
6,82561584,,Orbitocranial approach/skull,A,,36.76,33.67,NA,33.67,,14.34,84.77,84.77,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,82661585,,Orbitocranial approach/skull,A,,41.51,38.43,NA,38.43,,17.52,97.46,97.46,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,82761586,,Resect nasopharynx skull,A,,26.79,40.91,NA,40.91,,11.32,79.02,79.02,0,090,0.11,0.76,0.13,2,0,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,82861590,,Infratemporal approach/skull,A,,45.86,24.78,NA,24.78,,9.17,79.81,79.81,0,090,0.11,0.76,0.13,2,1,2,1,2,9,,33.4009,09,0,99,0.00,0.00,0.00
6,82961591,,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
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817