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CPT code 63042: Lumbar decompression, single-level re-exploration2026 Medicare rate & RVUs

Reports repeat surgery at one lumbar level to relieve nerve-root compression through a limited bone opening, with related facet, foramen, or disc work as indicated.

CMS RVU26DEffective Oct 1, 2026109 payment localities7K Medicare services in 2024

Medicare pays $1,219.80 for 63042 nationally in a facility.

Medicare rate · 63042

Lumbar decompression, single-level re-exploration

Office or facility?

Work RVUs
18.29
Total RVUs
36.52
Global days
090

National rate · 2026

$1,219.80

Facility setting, before claim adjustments.

See every locality for 63042 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 63042 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 63042 covers

A spine surgeon uses this service to revisit a previously operated lumbar level and relieve recurrent nerve-root compression. The work may include a limited opening in the posterior vertebral bone, partial facet removal, widening the nerve-root exit, and removal of herniated disc material when needed. A typical clinical situation is recurrent leg pain from nerve-root compression at a level treated surgically before. The code represents one lumbar level; additional re-exploration levels are addressed separately when supported.

Report this code when the operative report supports re-exploration at a single lumbar level and describes the nerve-root decompression performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid, and co-surgeons are permitted; team surgery is not 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.

Where 63042 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

63042 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,086.92
AlaskaUnavailable$1,470.41
ArizonaUnavailable$1,180.17
ArkansasUnavailable$1,070.75
Atlanta, GAUnavailable$1,265.36
Austin, TXUnavailable$1,224.74
Bakersfield, CAUnavailable$1,200.40
Baltimore area, MDUnavailable$1,304.15
Beaumont, TXUnavailable$1,168.49
Brazoria, TXUnavailable$1,180.45

63042 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
63042 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 63042 rate is calculated

Each of 63042’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 · 63042

RVUs × geographic indexes × conversion factor

Office or facility?

Work18.29

18.29 RVUs× 1.000 GPCI

Practice expense12.73

12.73 RVUs× 1.000 GPCI

Malpractice5.50

5.50 RVUs× 1.000 GPCI

Adjusted RVUs

36.5200

Conversion factor

$33.4009

Medicare rate

$1,219.80

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 63042

63042 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 63042

Lumbar decompression, single-level re-exploration

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)1Bilateral with modifier 50 pays 150% of the fee schedule amount.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)2Permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.11/0.76/0.13Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 63042

Lumbar decompression, single-level re-exploration

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 50 · payment effect

With and without the modifier

63042 without 50 · national facility

$1,219.80

Lumbar decompression, single-level re-exploration

63042-50 · Bilateral: 150%

$1,829.70

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).

When to use modifier 50

63042 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 63042

    Lumbar decompression, single-level re-exploration18.29 wRVU

    Not priced

  • 63030

    Lumbar decompression, single interspace11.7 wRVU

    Not priced

  • 63044

    Lumbar re-exploration, each additional interspace0 wRVU

    Not priced

  • 63047

    Lumbar decompression, single lumbar segment14.99 wRVU

    Not priced

How to choose

63030Lumbar decompressionSingle interspace
Both describe single-level lumbar nerve-root decompression, but 63042 is for re-exploration at a previously operated level; 63030 is the non-re-exploration counterpart.
63044Lumbar re-explorationEach additional interspace
63044 represents an additional lumbar level during re-exploration. Use 63042 for the single level, not for each additional level.
63047Lumbar decompressionSingle lumbar segment
63047 describes lumbar decompression with laminectomy, facetectomy, and foraminotomy. Choose based on the procedure performed and the code’s scope, rather than treating it as the re-exploration code.

Codes related to 63042

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 63042
CodeHow it relatesNational office range
Used instead
63030Lumbar decompression, single interspaceSingle-level lumbar nerve-root decompression when the procedure is not a re-exploration.No office rate
63040Cervical laminotomy, single cervical segmentSingle-level cervical re-exploration for nerve-root decompression.No office rate
63047Lumbar decompression, single lumbar segmentLumbar decompression involving laminectomy, facetectomy, and foraminotomy.No office rate
Add-on codes
63044Lumbar re-exploration, each additional interspaceAdd-on for each additional lumbar re-exploration level.No office rate

63042 billing questions

How does this differ from 63030?

63042 is for re-exploration at a previously operated lumbar level. 63030 is used for the corresponding single-level lumbar decompression when it is not a re-exploration.

Can the code include disc removal or foraminotomy?

Yes. The work may include partial facet removal, widening the nerve-root exit, or excision of herniated disc material as part of the decompression. The operative report should describe the work performed.

What supports reporting a re-exploration?

Document the previously operated lumbar level, the recurrent nerve-root compression being treated, and the decompression performed at that level. The record should make clear that the procedure revisits the prior operative site.

How is another lumbar level reported?

For an additional lumbar re-exploration level, consider 63044 when its requirements are met. The operative documentation should identify the additional level and the work performed there.

What payment rules apply to the surgical session?

This code has a 90-day global period, and same-session multiple procedures are subject to the standard reduction after the highest-valued procedure. Modifier 50 bilateral reporting is paid at 150%; an assistant may be paid and co-surgeons are permitted.

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
RVUs for 63042PPRRVU2026_Oct_nonQPP.csv, line 7,001 (RVU26D)

Open CMS sourceHow we calculate rates

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