No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
63042 Lumbar decompression Medicare reimbursement rates
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. Compare 63042 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 63042?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 63042 pays more and less
Spine surgery
About 63042: Lumbar nerve root decompression, re-exploration
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.
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.
CMS billing rules for 63042
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU18.29 · 50%
- Practice expense (office) RVU12.73 · 35%
- Malpractice RVU5.50 · 15%
7K
Medicare services in 2024 · #1661 by national volume
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.
63042 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
63044
No office rateLaminotomy addl lumbar
63044 represents an additional lumbar level during re-exploration. Use 63042 for the single level, not for each additional level.
No office rate
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.
See how rates vary across the country
63042 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | 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 |
Compare 63042 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1086.92 |
| Alaska* | Office Unavailable | Facility $1470.41 |
| Arizona | Office Unavailable | Facility $1180.17 |
| Arkansas | Office Unavailable | Facility $1070.75 |
| Atlanta | Office Unavailable | Facility $1265.36 |
| Austin | Office Unavailable | Facility $1224.74 |
| Bakersfield | Office Unavailable | Facility $1200.40 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $1304.15 |
| Beaumont | Office Unavailable | Facility $1168.49 |
| Brazoria | Office Unavailable | Facility $1180.45 |
| Chicago | Office Unavailable | Facility $1464.10 |
| Chico | Office Unavailable | Facility $1185.77 |
| Colorado | Office Unavailable | Facility $1214.11 |
| Connecticut | Office Unavailable | Facility $1303.34 |
| Dallas | Office Unavailable | Facility $1197.51 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $1349.23 |
| Delaware | Office Unavailable | Facility $1199.20 |
| Detroit | Office Unavailable | Facility $1330.94 |
| East St. Louis | Office Unavailable | Facility $1372.06 |
| El Centro | Office Unavailable | Facility $1186.68 |
| Fort Lauderdale | Office Unavailable | Facility $1373.76 |
| Fort Worth | Office Unavailable | Facility $1195.65 |
| Fresno | Office Unavailable | Facility $1185.77 |
| Galveston | Office Unavailable | Facility $1190.11 |
| Hanford-Corcoran | Office Unavailable | Facility $1185.77 |
| Hawaii, Guam | Office Unavailable | Facility $1200.71 |
| Houston | Office Unavailable | Facility $1290.78 |
| Idaho | Office Unavailable | Facility $1088.97 |
| Indiana | Office Unavailable | Facility $1094.34 |
| Iowa | Office Unavailable | Facility $1072.89 |
| Kansas | Office Unavailable | Facility $1087.86 |
| Kentucky | Office Unavailable | Facility $1156.99 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1260.93 |
| Madera | Office Unavailable | Facility $1185.77 |
| Manhattan | Office Unavailable | Facility $1435.43 |
| Merced | Office Unavailable | Facility $1185.77 |
| Metropolitan Boston | Office Unavailable | Facility $1307.13 |
| Metropolitan Kansas City | Office Unavailable | Facility $1189.64 |
| Metropolitan Philadelphia | Office Unavailable | Facility $1283.69 |
| Metropolitan St. Louis | Office Unavailable | Facility $1199.76 |
| Miami | Office Unavailable | Facility $1518.12 |
| Minnesota | Office Unavailable | Facility $1102.80 |
| Mississippi | Office Unavailable | Facility $1112.75 |
| Modesto | Office Unavailable | Facility $1185.77 |
| Montana** | Office Unavailable | Facility $1219.43 |
| Napa | Office Unavailable | Facility $1303.12 |
| Nebraska | Office Unavailable | Facility $1072.80 |
| Nevada** | Office Unavailable | Facility $1189.55 |
| New Hampshire | Office Unavailable | Facility $1214.27 |
| New Mexico | Office Unavailable | Facility $1221.43 |
| New Orleans | Office Unavailable | Facility $1219.70 |
| North Carolina | Office Unavailable | Facility $1125.00 |
| North Dakota** | Office Unavailable | Facility $1110.68 |
| Northern Nj | Office Unavailable | Facility $1338.81 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $1496.70 |
| Ohio | Office Unavailable | Facility $1184.28 |
| Oklahoma | Office Unavailable | Facility $1133.34 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1245.03 |
| Portland | Office Unavailable | Facility $1229.74 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $1326.26 |
| Puerto Rico | Office Unavailable | Facility $1221.72 |
| Queens | Office Unavailable | Facility $1417.48 |
| Redding | Office Unavailable | Facility $1185.77 |
| Rest Of California | Office Unavailable | Facility $1185.77 |
| Rest Of Florida | Office Unavailable | Facility $1293.50 |
| Rest Of Georgia | Office Unavailable | Facility $1209.15 |
| Rest Of Illinois | Office Unavailable | Facility $1286.23 |
| Rest Of Louisiana | Office Unavailable | Facility $1163.19 |
| Rest Of Maine | Office Unavailable | Facility $1116.34 |
| Rest Of Maryland | Office Unavailable | Facility $1215.95 |
| Rest Of Massachusetts | Office Unavailable | Facility $1214.82 |
| Rest Of Michigan | Office Unavailable | Facility $1206.51 |
| Rest Of Missouri | Office Unavailable | Facility $1156.35 |
| Rest Of New Jersey | Office Unavailable | Facility $1301.17 |
| Rest Of New York | Office Unavailable | Facility $1143.98 |
| Rest Of Oregon | Office Unavailable | Facility $1163.54 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1174.83 |
| Rest Of Texas | Office Unavailable | Facility $1180.30 |
| Rest Of Washington | Office Unavailable | Facility $1206.37 |
| Rhode Island | Office Unavailable | Facility $1225.60 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1244.61 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1225.86 |
| Salinas | Office Unavailable | Facility $1221.11 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1237.33 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $1352.78 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $1346.54 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $1389.70 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $1364.16 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1204.05 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1238.81 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1222.25 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1249.83 |
| Seattle (King Cnty) | Office Unavailable | Facility $1313.25 |
| South Carolina | Office Unavailable | Facility $1159.93 |
| South Dakota** | Office Unavailable | Facility $1097.82 |
| Southern Maine | Office Unavailable | Facility $1148.19 |
| Stockton | Office Unavailable | Facility $1185.77 |
| Suburban Chicago | Office Unavailable | Facility $1377.38 |
| Tennessee | Office Unavailable | Facility $1096.05 |
| Utah | Office Unavailable | Facility $1175.55 |
| Vallejo | Office Unavailable | Facility $1294.11 |
| Vermont | Office Unavailable | Facility $1124.80 |
| Virgin Islands | Office Unavailable | Facility $1221.72 |
| Virginia | Office Unavailable | Facility $1158.56 |
| Visalia | Office Unavailable | Facility $1185.77 |
| West Virginia | Office Unavailable | Facility $1243.28 |
| Wisconsin | Office Unavailable | Facility $1074.82 |
| Wyoming** | Office Unavailable | Facility $1172.04 |
| Yuba City | Office Unavailable | Facility $1185.77 |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
6,99863032,,Lamot rpr anulr dfct 1 lmbr,A,,2.50,0.79,NA,0.79,,0.79,4.08,4.08,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
6,99963035,,Lamot dcmprn nrv rt ea addl,A,,3.76,1.25,NA,1.25,,1.17,6.18,6.18,0,ZZZ,0.00,0.00,0.00,0,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,00063040,,Laminotomy single cervical,A,,19.80,12.61,NA,12.61,,6.15,38.56,38.56,0,090,0.11,0.76,0.13,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,00163042,,Laminotomy single lumbar,A,,18.29,12.73,NA,12.73,,5.50,36.52,36.52,0,090,0.11,0.76,0.13,2,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,00263043,,Laminotomy addl cervical,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,ZZZ,0.00,0.00,0.00,0,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,00363044,,Laminotomy addl lumbar,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,ZZZ,0.00,0.00,0.00,0,1,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,00463045,,Lam facetec & foramot crv,A,,17.50,13.58,NA,13.58,,6.33,37.41,37.41,0,090,0.11,0.76,0.13,2,2,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00