No office rate
Both address cervical intradural lesions, but 63285 is for a lesion within the spinal cord; 63280 is for one outside the cord.
On this page
CMS RVU26D · Effective 2026-10-01
63285 Spinal cord lesion Medicare reimbursement rates in Hawaii
Reports cervical laminectomy to biopsy or remove a neoplasm located within the spinal cord, beneath the dura. Compare 63285 office and facility rates across CMS payment localities in Hawaii.
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 63285 in Hawaii?
Hawaii 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
$2408.28
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
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.
Neurosurgery
About 63285: Cervical intramedullary lesion biopsy or excision
Reports cervical laminectomy to biopsy or remove a neoplasm located within the spinal cord, beneath the dura.
This service involves a posterior cervical laminectomy to reach an intradural, intramedullary neoplasm—one located within the spinal cord itself. The surgeon opens the dura to obtain a diagnostic tissue sample or remove the lesion. A neurosurgeon typically performs the operation in a hospital operating room; the code applies to the cervical region, not a lesion outside the dura or one in the surrounding space within the dura.
Select the code based on the documented cervical location and the lesion’s intramedullary position, rather than the biopsy-versus-removal intent alone. The operative report should identify the level, the lesion’s relationship to the dura and spinal cord, and whether tissue was sampled or the lesion was removed. 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 others at 50%. An assistant may be paid; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 63285
- 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 RVU37.10 · 49%
- Practice expense (office) RVU22.81 · 30%
- Malpractice RVU15.66 · 21%
56
Medicare services in 2024 · #5286 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.
63285 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
Use 63275 when the cervical neoplasm is extradural. Code 63285 requires an intradural, intramedullary location.
No office rate
The lesion compartment and biopsy-or-excision service are similar, but 63286 is for the thoracic region rather than the cervical region.
Compare 63285 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
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$2408.28
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
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 63285 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
7,059
- Code
- 63285
- Physician work
- 37.10
- Practice expense
- 22.81
- Malpractice
- 15.66
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 37.10 | × 1.000 | 37.1000 |
| Practice expense | 22.81 | × 1.137 | 25.9350 |
| Malpractice | 15.66 | × 0.579 | 9.0671 |
| Total RVUs | 72.1021 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$2408.28
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 37.1 | 1 |
| Practice expense | 22.81 | 1.137 |
| Malpractice | 15.66 | 0.579 |
(37.1 × 1 + 22.81 × 1.137 + 15.66 × 0.579) × $33.4009 = $2408.28
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.
63285 billing questions
How is this distinguished from code 63280?
Use 63285 for a lesion within the spinal cord. Code 63280 describes a cervical intradural lesion outside the cord.
Does this code cover biopsy as well as removal?
Yes. The code covers the cervical laminectomy service for biopsy or excision of an intradural, intramedullary neoplasm.
What operative documentation supports this code?
Document the cervical level, the lesion’s intradural and intramedullary location, and whether the surgeon sampled or removed it.
Can an assistant or co-surgeon be paid?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How does Medicare handle other procedures in the same session?
The highest-valued procedure is paid in full, and other procedures are paid at 50% under the standard multiple procedure reduction.
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.
7,05663281,,Bx/exc idrl spine lesn thrc,A,,29.24,19.83,NA,19.83,,12.20,61.27,61.27,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05763282,,Bx/exc idrl spine lesn lmbr,A,,27.45,19.16,NA,19.16,,11.41,58.02,58.02,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05863283,,Bx/exc idrl spine lesn scrl,A,,26.09,18.95,NA,18.95,,11.02,56.06,56.06,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05963285,,Bx/exc idrl imed lesn cervl,A,,37.10,22.81,NA,22.81,,15.66,75.57,75.57,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,06063286,,Bx/exc idrl imed lesn thrc,A,,36.68,22.61,NA,22.61,,15.39,74.68,74.68,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,06163287,,Bx/exc idrl imed lesn thrlmb,A,,39.08,23.50,NA,23.50,,16.49,79.07,79.07,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,06263290,,Bx/exc xdrl/idrl lsn any lvl,A,,39.80,23.76,NA,23.76,,16.81,80.37,80.37,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014