CPT code 63685: Neurostimulator generator, spinal pulse generator or receiver2026 Medicare rate & RVUs in Illinois
Placement or replacement of an implanted spinal neurostimulator generator or receiver in a pocket, commonly paired with epidural stimulation-lead implantation.
CMS doesn’t publish an office rate for 63685 in Illinois.
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 63685 covers
This service places or replaces the implanted pulse generator or receiver that powers a spinal cord neurostimulator. The surgeon creates or accesses a pocket, commonly in the flank or buttock, and connects the generator to the stimulation leads. Neurosurgeons and pain physicians commonly perform the procedure in an operating room, including after a successful temporary stimulation trial or when an implanted generator needs replacement.
Report the generator or receiver service for the implanted power unit; lead implantation is a separate service when performed and coded. Operative documentation should identify whether the unit was newly implanted or replaced, the pocket work, and its connection to the stimulation system. Related postoperative visits for 10 days are included. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this descriptor and anatomy. Medicare may pay an assistant at surgery; co-surgeon payment requires supporting documentation, and 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 63685 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | Unavailable | $365.82 |
| East St. Louis, IL | Unavailable | $345.04 |
| Rest of Illinois | Unavailable | $328.42 |
| Suburban Chicago, IL | Unavailable | $350.00 |
How the 63685 rate is calculated
Each of 63685’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 · 63685
RVUs × geographic indexes × conversion factor
Work5.06
5.06 RVUs× 1.000 GPCI
Practice expense3.43
3.43 RVUs× 1.000 GPCI
Malpractice1.05
1.05 RVUs× 1.000 GPCI
Adjusted RVUs
9.5400
Conversion factor
$33.4009
Medicare rate
$318.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 63685
63685 has a 10-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 63685
Neurostimulator generator, spinal pulse generator or receiver
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 010 | Minor procedure: the day of the procedure plus 10 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.80/0.10 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 63685
Neurostimulator generator, spinal pulse generator or receiver
10-day global period ends
Oct 11, 2026
Covers Oct 1, 2026 through Oct 11, 2026 (11 days).
Visit on Oct 31, 2026
After the global period ends: visits and procedures are billed normally.
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
63685 without 51 · national facility
$318.64
Neurostimulator generator, spinal pulse generator or receiver
63685-51 · Second procedure: 50%
$159.32
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
63685 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 63650Neurostimulator leadPercutaneous epidural array
- 63650 covers percutaneous implantation of spinal stimulation electrodes. Use 63685 for the generator or receiver placed in a pocket.
- 63655Paddle lead implantLaminectomy approach
- 63655 covers open implantation of spinal stimulation electrodes. It is distinct from placing or replacing the generator or receiver under 63685.
- 63688Spinal stimulatorGenerator revision or removal
- 63688 describes revision or removal of the implanted generator or receiver; 63685 describes insertion or replacement.
63685 billing questions
How is this different from spinal electrode implantation?
This code covers the implanted generator or receiver in its pocket. Codes 63650 and 63655 describe spinal electrode implantation, not the generator.
Can the generator and lead procedures be reported together?
Yes, when both the generator or receiver and spinal electrodes are implanted during the encounter, report the applicable code for each service, subject to applicable edits.
When should 63688 be considered instead?
Use 63685 for insertion or replacement of the generator or receiver. Code 63688 describes revision or removal of that implanted component.
Should modifier 50 be appended for a generator on each side?
No. CMS identifies modifier 50 as inappropriate for this descriptor and anatomy; report the generator service without bilateral reporting.
What documentation supports reporting this code?
Document whether the generator or receiver was newly placed or replaced, the pocket procedure, and its connection to the spinal stimulation system.
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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