CPT code 63091: Vertebral body removal, additional lumbar segment2026 Medicare rate & RVUs in Texas
Reports removal of an additional lumbar vertebral segment for spinal cord or nerve root decompression after the primary lumbar vertebral body procedure.
CMS doesn’t publish an office rate for 63091 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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.
Where 63091 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $156.75 |
| Beaumont, TX | Unavailable | $153.17 |
| Brazoria, TX | Unavailable | $152.25 |
| Dallas, TX | Unavailable | $154.72 |
| Fort Worth, TX | Unavailable | $154.78 |
| Galveston, TX | Unavailable | $153.67 |
| Houston, TX | Unavailable | $169.23 |
| Rest of Texas | Unavailable | $153.65 |
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.
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.
63091 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 63090Vertebral corpectomyLumbar, abdominal approach
- 63090 is the primary lumbar vertebral body removal and decompression procedure. 63091 is reported for an additional lumbar segment during that procedure.
- 63088Vertebral resectionAdditional thoracolumbar segment
- 63088 describes an additional vertebral segment in the thoracolumbar region. 63091 is the additional-segment code for the lumbar region.
- 63056Spinal decompressionLumbar, single segment
- 63056 describes lumbar decompression through a transpedicular approach. 63091 is for removal of an additional lumbar vertebral segment through an anterior approach with decompression.
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
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