No office rate
Both concern nonneoplastic cervical spinal lesions, but this code is for an extradural lesion; 63270 is for an intradural, extramedullary lesion.
On this page
CMS RVU26D · Effective 2026-10-01
63265 Spinal lesion removal Medicare reimbursement rates in Connecticut
Reports cervical laminectomy to remove or evacuate a nonneoplastic lesion outside the dura, such as an epidural abscess or hematoma. Compare 63265 office and facility rates across CMS payment localities in Connecticut.
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 63265 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1733.62
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
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.
Spinal surgery
About 63265: Cervical extradural nonneoplastic lesion removal
Reports cervical laminectomy to remove or evacuate a nonneoplastic lesion outside the dura, such as an epidural abscess or hematoma.
A neurosurgeon or spine surgeon uses a cervical laminectomy to reach and remove or evacuate a lesion in the spinal canal but outside the dura. Typical situations include surgery for a cervical epidural abscess or hematoma. The lesion must be nonneoplastic; the code is not selected just because a lesion is found during a cervical spine operation. The operative report should establish the cervical level, extradural location, nonneoplastic nature, and removal or evacuation performed.
Report the service for the lesion operation, including the laminectomy exposure used to reach it, rather than separately coding that exposure. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. A bilateral adjustment is not appropriate. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 63265
- 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 adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU23.22 · 48%
- Practice expense (office) RVU16.09 · 33%
- Malpractice RVU9.00 · 19%
782
Medicare services in 2024 · #3176 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.
63265 compared with similar codes
Office rates for Connecticut, from the same CMS release.
No office rate
Use this code for a nonneoplastic extradural cervical lesion. Code 63275 is for biopsy or excision of a neoplastic extradural lesion.
No office rate
The lesion type and extradural location are comparable, but 63266 applies to the thoracic region rather than the cervical region.
Compare 63265 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.
1 of 1 payment localities
Connecticut →
Office / nonfacility
Unavailable
Facility
$1733.62
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 63265 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
7,043
- Code
- 63265
- Physician work
- 23.22
- Practice expense
- 16.09
- Malpractice
- 9.00
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 23.22 | × 1.020 | 23.6844 |
| Practice expense | 16.09 | × 1.077 | 17.3289 |
| Malpractice | 9.00 | × 1.210 | 10.8900 |
| Total RVUs | 51.9033 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$1733.62
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 23.22 | 1.02 |
| Practice expense | 16.09 | 1.077 |
| Malpractice | 9 | 1.21 |
(23.22 × 1.02 + 16.09 × 1.077 + 9 × 1.21) × $33.4009 = $1733.62
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
63265 billing questions
How does this differ from code 63270?
This code is for a nonneoplastic lesion outside the dura. Code 63270 is for a nonneoplastic lesion inside the dura but outside the spinal cord.
When would code 63275 be used instead?
Code 63275 describes biopsy or excision of an extradural cervical spinal lesion when the lesion is neoplastic. This code is for a nonneoplastic extradural lesion.
Can the cervical laminectomy exposure be billed separately?
The laminectomy exposure used to reach and remove or evacuate the lesion is part of this operative service; do not separately report it for the same exposure.
Does modifier 50 apply to bilateral cervical levels?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
What documentation supports reporting this code?
Document the cervical site, that the lesion is extradural and nonneoplastic, and the removal or evacuation performed. The operative report should make the lesion compartment clear.
How are assistant and co-surgeon services handled?
Assistant-at-surgery payment may be made. 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 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.
7,04063250,,Revise spinal cord vsls crvl,A,,42.76,24.05,NA,24.05,,18.05,84.86,84.86,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04163251,,Revise spinal cord vsls thrc,A,,43.52,25.07,NA,25.07,,18.37,86.96,86.96,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04263252,,Revise spine cord vsl thrlmb,A,,43.51,25.06,NA,25.06,,18.37,86.94,86.94,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04363265,,Excise intraspinl lesion crv,A,,23.22,16.09,NA,16.09,,9.00,48.31,48.31,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04463266,,Excise intrspinl lesion thrc,A,,24.06,16.33,NA,16.33,,9.25,49.64,49.64,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04563267,,Excise intrspinl lesion lmbr,A,,18.96,13.93,NA,13.93,,6.71,39.60,39.60,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04663268,,Excise intrspinl lesion scrl,A,,19.52,15.88,NA,15.88,,8.24,43.64,43.64,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808