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Billing code 63191: Nerve incisionMedicare rate & RVUs

Reports operative incision or division of the spinal accessory nerve, including selected procedures for severe cervical dystonia when that nerve is the surgical target.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,376.79 for 63191 nationally in a facility.

Medicare rate · 63191

Nerve incision

Work RVUs
18.45
Total RVUs
41.22
Global days
090

National rate · 2026

$1,376.79

Facility setting, before claim adjustments.

See every locality for 63191 →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.

On this page 10 sections
  1. Medicare rate
  2. What 63191 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 63191 covers

The surgeon exposes and incises or divides the spinal accessory nerve as the intended neural target. A neurosurgeon or other surgeon qualified to perform the procedure may use it in selected cases of severe cervical dystonia or spasmodic torticollis. The operative report should identify the spinal accessory nerve and describe the surgical work performed; procedures on spinal nerve roots or spinal cord tracts involve different targets.

Report 63191 when the documented operation is directed at the spinal accessory nerve, not simply because another cervical nerve procedure was performed. Record the indication, laterality, nerve treated, and operative details supporting the service. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures occur in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard multiple-procedure reduction. Bilateral reporting with modifier 50 is paid at 150%. Assistant-at-surgery services may be paid; 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 63191 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

63191 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,201.52
Alaska*Unavailable$1,600.95
ArizonaUnavailable$1,323.88
ArkansasUnavailable$1,180.27
AtlantaUnavailable$1,438.81
AustinUnavailable$1,377.49
BakersfieldUnavailable$1,335.12
Baltimore/Surr. CntysUnavailable$1,484.73
BeaumontUnavailable$1,313.27
BrazoriaUnavailable$1,320.11

63191 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
63191 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 63191 rate is calculated

Each of 63191’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 · 63191

RVUs × geographic indexes × conversion factor

Work18.45

18.45 RVUs× 1.000 GPCI

Practice expense15.00

15.00 RVUs× 1.000 GPCI

Malpractice7.77

7.77 RVUs× 1.000 GPCI

Adjusted RVUs

41.2200

Conversion factor

$33.4009

Medicare rate

$1,376.79

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

Payment rules and modifiers for 63191

63191 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 63191

Nerve incision

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)1Permitted with supporting documentation.
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 · 63191

Nerve incision

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

63191 without 50 · national facility

$1,376.79

Nerve incision

63191-50 · Bilateral: 150%

$2,065.19

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

63191 compared with similar codes

Compare codes · National

4 codes, side by side

  • 63191

    Nerve incision18.45 wRVU

    Not priced

  • 63185

    Spinal rhizotomy16.08 wRVU

    Not priced

  • 63190

    Spinal rhizotomy18.42 wRVU

    Not priced

  • 63170

    Spinal cord surgery21.65 wRVU

    Not priced

How to choose

63185Spinal rhizotomy
63185 concerns a spinal nerve procedure with limited segment involvement. Use 63191 when the spinal accessory nerve is the operative target.
63190Spinal rhizotomy
63190 concerns a spinal nerve procedure involving more than two segments. It is not the code for incision of the spinal accessory nerve.
63170Spinal cord surgery
63170 involves incision of spinal cord tracts. Choose 63191 when the documented target is the spinal accessory nerve instead.

Codes related to 63191

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

Codes related to 63191
CodeHow it relatesNational office range
Same family
63185Spinal rhizotomyRelated spinal nerve procedure; distinguish it by the nerve target and documented segment involvement.No office rate
63190Spinal rhizotomyRelated spinal nerve procedure for a different documented extent or nerve target.No office rate
Used instead
63170Spinal cord surgeryTargets spinal cord tracts rather than the spinal accessory nerve.No office rate

63191 billing questions

How does 63191 differ from spinal nerve root incision codes?

63191 targets the spinal accessory nerve. Codes 63185 and 63190 concern spinal nerve procedures distinguished by the extent or segment involvement.

Is this code appropriate for every operation for cervical dystonia?

No. Report it when the spinal accessory nerve is the nerve surgically incised or divided; a different operative target calls for its own code.

Can modifier 50 be used for bilateral treatment?

CMS identifies this as a bilateral procedure. Bilateral reporting with modifier 50 is paid at 150%.

What postoperative care is included?

The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures are subject to the standard multiple-procedure reduction.

May an assistant or co-surgeon be reported?

Assistant-at-surgery services may be paid. Co-surgeon payment requires supporting documentation; team surgery is not 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 63191PPRRVU2026_Oct_nonQPP.csv, line 7,037 (RVU26D)

Open CMS sourceHow we calculate rates

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