2025 CPT code 61215

Insertion of a subcutaneous reservoir, pump, or continuous infusion system connected to a ventricular catheter.

Consult the current CPT and payer-specific coding guidelines for specific rules and requirements.The correct use of modifiers might be required depending on the circumstances of the procedure (e.g., modifier 59 for distinct procedural services).

Modifiers such as 59 (distinct procedural service) might be needed if this procedure is performed with other procedures.

Medical necessity for this procedure is established based on the patient's condition requiring long-term medication delivery. This would typically include conditions like intractable pain, where oral or other medication routes are ineffective, or certain types of cancer requiring intrathecal chemotherapy.Documentation supporting the diagnosis and the need for the procedure is crucial for reimbursement.

The neurosurgeon or a qualified physician specializing in this type of procedure is responsible for the surgical placement of the device. This includes creating the subcutaneous pocket, inserting the catheter and connecting it to the device, testing its function, and closing the incision.Post-operative care and management may involve other medical professionals.

IMPORTANT For refilling and maintenance of an implantable infusion pump, use 95990. For chemotherapy administration, use 96450. For injection of drugs (excluding chemotherapeutic agents), use 61026.Codes 61210 and 61215 may be used together, but modifier 59 or X{EPSU} might be required if they represent distinct procedural services.

In simple words: The doctor places a small device under the skin to deliver medicine over a long period. A thin tube connects the device to a catheter already placed in the brain. This is often used for pain relief or chemotherapy.

This CPT code describes the surgical insertion of an implantable reservoir, pump, or continuous infusion system beneath the skin.The procedure involves creating a subcutaneous pocket, usually in the scalp,inserting a tunneled catheter connected to the device, testing its functionality, securing the device in the pocket, and closing the incision. This system is designed for long-term, continuous or intermittent medication administration, often through a ventricular catheter, for conditions like pain management or chemotherapy delivery to the cerebrospinal fluid (CSF).

Example 1: A patient with chronic intractable pain receives an implanted drug delivery system connected to an intrathecal catheter for long-term pain management. Code 61215 would be used to bill for the surgical placement of the reservoir., A patient with brain cancer requires intrathecal chemotherapy.Code 61215 reports the surgical insertion of a subcutaneous reservoir connected to a ventricular catheter for drug delivery. Chemotherapy administration would be billed separately (e.g., 96450)., A patient needs revision of their existing Ommaya reservoir.Code 61215 would be used to bill for the revision and replacement of the device if applicable.However, specific coding might differ depending on the details of the revision and would require consultation with coding guidelines.

* Detailed operative report describing the surgical procedure.* Pre-operative imaging studies (e.g., CT scan, MRI) to identify the location for catheter placement.* Post-operative imaging to confirm device placement.* Records of device testing to ensure functionality.* Medical necessity documentation supporting the need for continuous medication delivery, especially for pain management or chemotherapy.

** The use of code 61215 is specific to the surgical implantation of the reservoir, pump, or infusion system.Subsequent refills, maintenance, or removal of the device are reported using separate codes.

  • Revenue Code: P1G (Major Procedure - Other)
  • RVU: The RVUs for this code will vary depending on the specific location and payer. Consult the appropriate fee schedule for your region and the specific payer.
  • Global Days : The global period for this procedure is likely dependent on the specific device implanted and the payer's policies.It's not explicitly defined within the code description.
  • Payment Status: Active
  • Modifier TC rule: A technical component (TC) modifier is not typically applicable to this procedure code.
  • Fee Schedule : Historical fee schedule data is not readily available but can be obtained from payer-specific sources or historical fee databases.
  • Specialties:Neurosurgery, neurology, oncology, anesthesiology (for anesthesia related to the procedure)
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center
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