CPT code 63091: Vertebral body removal, additional lumbar segment2026 Medicare rate & RVUs in Puerto Rico
Reports removal of an additional lumbar vertebral segment for spinal cord or nerve root decompression after the primary lumbar vertebral body procedure.
In Puerto Rico, Medicare pays $157.90 for 63091 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 63091 nationwide
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 11 sections
What 63091 covers
This add-on describes removal of another lumbar vertebral body segment through an anterior approach as part of decompression of the spinal cord or nerve roots. A spine surgeon or neurosurgeon may perform the work in a hospital operating room for conditions requiring decompression at multiple lumbar levels. The code represents an additional segment, not a separate primary operation or removal of additional bone within the same segment.
Report 63091 only with the primary lumbar procedure, 63090. The operative report should identify the lumbar levels treated, the additional vertebral segment removed, the anterior approach, and the decompression performed. CMS classifies 63091 as an add-on code, so it is billed with a primary procedure and paid within that procedure’s global period.
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.
How Puerto Rico compares for 63091
Across 109 of 109 payment localities, the facility rate for 63091 runs from $137.04 in Wisconsin to $202.67 in Miami, FL. Puerto Rico pays $157.90. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$157.90
- Los Angeles, CA · California$158.17+$0.27
- Washington, DC area · District of Columbia$172.04+$14.14
- Miami, FL · Florida$202.67+$44.77
- Chicago, IL · Illinois$195.60+$37.70
- Manhattan, NY · New York$185.96+$28.06
- Alaska · Alaska$196.52+$38.62
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $141.78 |
| ArkansasArkansas | — | $139.84 |
| ArizonaArizona | — | $152.94 |
| Bakersfield, CACalifornia | — | $151.74 |
| Chico, CACalifornia | — | $149.47 |
| El Centro, CACalifornia | — | $149.61 |
| Fresno, CACalifornia | — | $149.47 |
| Hanford, CACalifornia | — | $149.47 |
| Madera, CACalifornia | — | $149.47 |
| Merced, CACalifornia | — | $149.47 |
| Modesto, CACalifornia | — | $149.47 |
| Napa, CACalifornia | — | $160.10 |
| Oxnard, CACalifornia | — | $155.70 |
| Redding, CACalifornia | — | $149.47 |
| Rest of CaliforniaCalifornia | — | $149.47 |
| Riverside, CACalifornia | — | $158.57 |
| Sacramento, CACalifornia | — | $153.42 |
| Salinas, CACalifornia | — | $152.81 |
| San Diego, CACalifornia | — | $154.03 |
| Marin County, CACalifornia | — | $164.72 |
| San Francisco, CACalifornia | — | $163.76 |
| San Benito County, CACalifornia | — | $169.38 |
| Santa Clara County, CACalifornia | — | $165.43 |
| San Luis Obispo, CACalifornia | — | $150.81 |
| Santa Cruz, CACalifornia | — | $153.56 |
| Santa Maria, CACalifornia | — | $152.73 |
| Santa Rosa, CACalifornia | — | $154.85 |
| Stockton, CACalifornia | — | $149.47 |
| Vallejo, CACalifornia | — | $158.71 |
| Visalia, CACalifornia | — | $149.47 |
| Yuba City, CACalifornia | — | $149.47 |
| ColoradoColorado | — | $154.94 |
| ConnecticutConnecticut | — | $168.31 |
| DelawareDelaware | — | $155.24 |
| Fort Lauderdale, FLFlorida | — | $181.33 |
| Rest of FloridaFlorida | — | $170.90 |
| Atlanta, GAGeorgia | — | $164.49 |
| Rest of GeorgiaGeorgia | — | $160.08 |
| Hawaii, Guam, HIHawaii | — | $150.29 |
| IowaIowa | — | $138.23 |
| IdahoIdaho | — | $140.54 |
| East St. Louis, ILIllinois | — | $184.29 |
| Rest of IllinoisIllinois | — | $171.27 |
| Suburban Chicago, ILIllinois | — | $181.43 |
| IndianaIndiana | — | $141.13 |
| KansasKansas | — | $140.92 |
| KentuckyKentucky | — | $152.13 |
| New Orleans, LALouisiana | — | $160.01 |
| Rest of LouisianaLouisiana | — | $153.22 |
| Metropolitan Boston, MAMassachusetts | — | $164.93 |
| Rest of MassachusettsMassachusetts | — | $155.45 |
| Baltimore area, MDMaryland | — | $168.56 |
| Rest of MarylandMaryland | — | $157.02 |
| Rest of MaineMaine | — | $144.77 |
| Southern Maine, MEMaine | — | $147.23 |
| Detroit, MIMichigan | — | $176.38 |
| Rest of MichiganMichigan | — | $158.95 |
| MinnesotaMinnesota | — | $138.90 |
| Metropolitan Kansas City, MOMissouri | — | $155.44 |
| Metropolitan St. Louis, MOMissouri | — | $156.55 |
| Rest of MissouriMissouri | — | $152.96 |
| MississippiMississippi | — | $146.26 |
| MontanaMontana | — | $157.93 |
| North CarolinaNorth Carolina | — | $145.66 |
| North DakotaNorth Dakota | — | $141.12 |
| NebraskaNebraska | — | $137.94 |
| New HampshireNew Hampshire | — | $155.71 |
| Northern New JerseyNew Jersey | — | $171.09 |
| Rest of New JerseyNew Jersey | — | $167.54 |
| New MexicoNew Mexico | — | $161.11 |
| NevadaNevada | — | $153.28 |
| NYC suburbs and Long Island, NYNew York | — | $194.49 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $171.33 |
| Queens, NYNew York | — | $182.49 |
| Rest of New YorkNew York | — | $148.00 |
| OhioOhio | — | $155.51 |
| OklahomaOklahoma | — | $148.33 |
| Portland, OROregon | — | $155.74 |
| Rest of OregonOregon | — | $149.43 |
| Metropolitan Philadelphia, PAPennsylvania | — | $166.51 |
| Rest of PennsylvaniaPennsylvania | — | $153.88 |
| Rhode IslandRhode Island | — | $157.82 |
| South CarolinaSouth Carolina | — | $151.37 |
| South DakotaSouth Dakota | — | $139.13 |
| TennesseeTennessee | — | $142.01 |
| Austin, TXTexas | — | $156.75 |
| Beaumont, TXTexas | — | $153.17 |
| Brazoria, TXTexas | — | $152.25 |
| Dallas, TXTexas | — | $154.72 |
| Fort Worth, TXTexas | — | $154.78 |
| Galveston, TXTexas | — | $153.67 |
| Houston, TXTexas | — | $169.23 |
| Rest of TexasTexas | — | $153.65 |
| UtahUtah | — | $153.23 |
| VirginiaVirginia | — | $149.11 |
| Virgin Islands, VIUnited States Virgin Islands | — | $157.90 |
| VermontVermont | — | $143.65 |
| Rest of WashingtonWashington | — | $154.13 |
| King County, WAWashington | — | $164.77 |
| WisconsinWisconsin | — | $137.04 |
| West VirginiaWest Virginia | — | $166.15 |
| WyomingWyoming | — | $150.60 |
63091 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 63091 rate is calculated
Each of 63091’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 · 63091
RVUs × geographic indexes × conversion factor
Work2.95
2.95 RVUs× 1.000 GPCI
Practice expense0.93
0.93 RVUs× 1.000 GPCI
Malpractice0.85
0.85 RVUs× 1.000 GPCI
Adjusted RVUs
4.7300
Conversion factor
$33.4009
Medicare rate
$157.99
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
7,028
- Code
- 63091
- Physician work
- 2.95
- Practice expense
- 0.93
- Malpractice
- 0.85
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.95 | × 1.000 | 2.9500 |
| Practice expense | 0.93 | × 1.011 | 0.9402 |
| Malpractice | 0.85 | × 0.985 | 0.8372 |
| Total RVUs | 4.7275 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$157.90
Facility: (2.95 × 1 + 0.93 × 1.011 + 0.85 × 0.985) × $33.4009 = $157.90
Payment rules and modifiers for 63091
The CMS indicators that decide how 63091 is paid alongside other services.
CMS payment indicators · 63091
Vertebral body removal, additional lumbar segment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 2 | Permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
63091 without 80 · national facility
$157.99
Vertebral body removal, additional lumbar segment
63091-80 · Assistant: 16%
$25.28
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
How 63091 has changed in Puerto Rico
63091 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $157.90 | RVU26D |
| 2026-07-01 | Not available in this setting | $157.90 | RVU26C |
| 2026-04-01 | Not available in this setting | $157.90 | RVU26B |
| 2026-01-01 | Not available in this setting | $157.90 | RVU26A |
| 2025-10-01 | Not available in this setting | $169.36 | RVU25D |
| 2025-07-01 | Not available in this setting | $169.36 | RVU25C |
| 2025-04-01 | Not available in this setting | $169.36 | RVU25B |
| 2025-01-01 | Not available in this setting | $169.36 | RVU25A |
| 2024-10-01 | Not available in this setting | $173.94 | RVU24D |
| 2024-07-01 | Not available in this setting | $173.94 | RVU24C |
| 2024-04-01 | Not available in this setting | $173.94 | RVU24B |
| 2024-03-09 | Not available in this setting | $173.94 | RVU24AR |
| 2024-01-01 | Not available in this setting | $171.10 | RVU24A |
| 2023-10-01 | Not available in this setting | $177.18 | RVU23D |
| 2023-07-01 | Not available in this setting | $177.23 | RVU23C |
| 2023-04-01 | Not available in this setting | $177.23 | RVU23B |
| 2023-01-01 | Not available in this setting | $177.23 | RVU23A |
| 2022-10-01 | Not available in this setting | $181.00 | RVU22D |
| 2022-07-01 | Not available in this setting | $181.00 | RVU22C |
| 2022-04-01 | Not available in this setting | $181.00 | RVU22B |
| 2022-01-01 | Not available in this setting | $181.00 | RVU22A |
| 2021-10-01 | Not available in this setting | $182.18 | RVU21D |
| 2021-07-01 | Not available in this setting | $182.18 | RVU21C |
| 2021-04-01 | Not available in this setting | $182.18 | RVU21B |
| 2021-01-01 | Not available in this setting | $182.18 | RVU21A |
| 2020-10-01 | Not available in this setting | $187.03 | RVU20D |
| 2020-07-01 | Not available in this setting | $187.03 | RVU20C |
| 2020-04-01 | Not available in this setting | $187.03 | RVU20B |
| 2020-01-01 | Not available in this setting | $187.03 | RVU20A |
| 2019-10-01 | Not available in this setting | $186.77 | RVU19D |
| 2019-07-01 | Not available in this setting | $186.77 | RVU19C |
| 2019-04-01 | Not available in this setting | $186.77 | RVU19B |
| 2019-01-01 | Not available in this setting | $186.77 | RVU19A |
| 2018-10-01 | Not available in this setting | $186.93 | RVU18D |
| 2018-07-01 | Not available in this setting | $186.93 | RVU18C |
| 2018-04-01 | Not available in this setting | $186.93 | RVU18B |
| 2018-01-01 | Not available in this setting | $186.93 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $169.34 | RVU17D |
| 2017-07-01 | Not available in this setting | $169.34 | RVU17C |
| 2017-04-01 | Not available in this setting | $169.34 | RVU17B |
| 2017-01-01 | Not available in this setting | $169.34 | RVU17A |
| 2016-10-01 | Not available in this setting | $151.93 | RVU16D |
| 2016-07-01 | Not available in this setting | $151.93 | RVU16C |
| 2016-04-01 | Not available in this setting | $151.93 | RVU16B |
| 2016-01-01 | Not available in this setting | $151.93 | RVU16A |
| 2015-10-01 | Not available in this setting | $152.98 | RVU15D |
| 2015-07-01 | Not available in this setting | $152.98 | RVU15C |
| 2015-04-01 | Not available in this setting | $152.22 | RVU15B |
| 2015-01-01 | Not available in this setting | $152.22 | RVU15A |
| 2014-10-01 | Not available in this setting | $150.80 | RVU14D |
| 2014-07-01 | Not available in this setting | $150.80 | RVU14C |
| 2014-04-01 | Not available in this setting | $150.80 | RVU14B |
| 2014-01-01 | Not available in this setting | $150.80 | RVU14A |
| 2013-10-01 | Not available in this setting | $144.37 | RVU13D |
| 2013-07-01 | Not available in this setting | $144.37 | RVU13C |
| 2013-04-01 | Not available in this setting | $144.37 | RVU13B |
| 2013-01-01 | Not available in this setting | $144.37 | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
63091 billing questions
Can 63091 be reported by itself?
No. It is an add-on code and is reported with the primary lumbar vertebral body removal procedure, 63090.
How is 63091 different from 63090?
63090 reports the primary lumbar vertebral segment removal. Use 63091 for an additional lumbar vertebral segment treated during the procedure.
What should the operative report document?
Document the anterior approach, decompression, and each lumbar vertebral segment removed, including which segment is additional to the primary level.
How are units determined?
Report the additional segment or segments treated, rather than counting bone fragments or separate pieces removed from one segment.
How does 63091 differ from 63088?
Both describe an additional vertebral segment removal, but 63091 is for the lumbar region; 63088 is for the thoracolumbar region.
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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