Billing code 63055: Spinal decompressionMedicare rate & RVUs in Illinois
Reports posterior transpedicular decompression at one thoracic spinal segment, commonly for a disc herniation compressing the cord or nerve roots.
CMS doesn’t publish an office rate for 63055 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.
On this page 9 sections
What 63055 covers
A spine surgeon, commonly an orthopedic spine surgeon or neurosurgeon, uses a posterior transpedicular route to reach and decompress neural structures at one thoracic segment. A typical situation is a thoracic disc herniation compressing the spinal cord or nerve roots when this route is selected for access. Medicare claims for this service are predominantly for facility procedures.
Report one unit for the documented thoracic segment treated with this approach. The operative report should identify the spinal level, transpedicular route, compressive pathology, and decompression performed. Code 63057 is the add-on for each additional segment when its requirements are met. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. 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. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; 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 63055 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 | Unavailable | $1,931.27 |
| East St. Louis | Unavailable | $1,803.03 |
| Rest Of Illinois | Unavailable | $1,670.58 |
| Suburban Chicago | Unavailable | $1,792.74 |
How the 63055 rate is calculated
Each of 63055’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 · 63055
RVUs × geographic indexes × conversion factor
Work22.96
22.96 RVUs× 1.000 GPCI
Practice expense14.98
14.98 RVUs× 1.000 GPCI
Malpractice8.56
8.56 RVUs× 1.000 GPCI
Adjusted RVUs
46.5000
Conversion factor
$33.4009
Medicare rate
$1,553.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 63055
63055 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 63055
Spinal decompression
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 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) | 0.11/0.76/0.13 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 63055
Spinal decompression
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
63055 without 51 · national facility
$1,553.14
Spinal decompression
63055-51 · Second procedure: 50%
$776.57
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%).
63055 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 63056Spinal decompression
- Use 63055 for a thoracic segment and 63056 for a lumbar segment when the transpedicular decompression approach is performed.
- 63057Spinal decompression
- 63055 reports the primary thoracic segment; 63057 is the add-on for each additional segment and is not reported alone.
- 63064Spinal decompression
- Both address thoracic spinal cord decompression, but 63064 describes a costovertebral route rather than the transpedicular route represented by 63055.
- 63046Thoracic decompression
- 63046 describes thoracic decompression through a laminectomy, facetectomy, and foraminotomy approach; 63055 is selected for the transpedicular approach.
63055 billing questions
How is this different from code 63056?
Both describe transpedicular decompression, but 63055 is for a thoracic segment and 63056 is for a lumbar segment. Select the code based on the treated spinal region.
When can code 63057 be reported with 63055?
Code 63057 is the add-on for each additional segment when more than one segment is treated. Document each level and the work performed; do not use it as a standalone primary procedure.
Should modifier 50 be used for bilateral decompression?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service based on the documented segment and applicable coding instructions.
What documentation supports reporting 63055?
The operative report should establish the thoracic level, transpedicular approach, compressive condition, and decompression performed. It should also distinguish any additional segment treated.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. The related care is included in the surgical global period.
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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