No office rate
Choose 63746 when the shunt is taken out. Choose 63744 when the surgeon revises or replaces the existing shunt.
On this page
CMS RVU26D · Effective 2026-10-01
63746 Shunt removal Medicare reimbursement rates in Iowa
Reports operative removal of an implanted spinal cerebrospinal-fluid shunt when the device is taken out, rather than revised or newly placed. Compare 63746 office and facility rates across CMS payment localities in Iowa.
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 63746 in Iowa?
Iowa 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
$556.84
1 of 1 localities have a supported rate.
Payment area: Iowa
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 63746: Operative spinal shunt removal
Reports operative removal of an implanted spinal cerebrospinal-fluid shunt when the device is taken out, rather than revised or newly placed.
Code 63746 represents operative removal of an implanted shunt that diverts cerebrospinal fluid from the spinal space. A neurosurgeon or other surgeon with relevant expertise typically performs the procedure in an operating room, accessing the implanted catheter and removing the shunt hardware. Removal may be indicated when the device is no longer needed or must be taken out; correcting or replacing an existing shunt points instead toward a revision service.
Report this code when the operative note identifies the spinal shunt and documents its removal, not for placement or revision alone. CMS assigns a 90-day major-surgery global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons and team surgery are not permitted.
CMS billing rules for 63746
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU7.15 · 37%
- Practice expense (office) RVU9.10 · 47%
- Malpractice RVU3.01 · 16%
26
Medicare services in 2024 · #5770 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.
63746 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
63740 describes spinal shunt installation; 63746 describes removal of an implanted spinal shunt.
No office rate
63741 is an installation service, whereas 63746 is reported for operative removal of the existing spinal shunt.
Compare 63746 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
Iowa →
Office / nonfacility
Unavailable
Facility
$556.84
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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 63746 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
7,095
- Code
- 63746
- Physician work
- 7.15
- Practice expense
- 9.10
- Malpractice
- 3.01
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 7.15 | × 1.000 | 7.1500 |
| Practice expense | 9.10 | × 0.915 | 8.3265 |
| Malpractice | 3.01 | × 0.397 | 1.1950 |
| Total RVUs | 16.6715 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$556.84
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 7.15 | 1 |
| Practice expense | 9.1 | 0.915 |
| Malpractice | 3.01 | 0.397 |
(7.15 × 1 + 9.1 × 0.915 + 3.01 × 0.397) × $33.4009 = $556.84
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.
63746 billing questions
How does 63746 differ from 63744?
Use 63746 when the spinal shunt is removed. Use 63744 when the surgeon revises or replaces an existing shunt rather than simply taking it out.
Does the 90-day global include postoperative visits?
Yes. The CMS global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be reported?
No. CMS identifies bilateral adjustment as inappropriate for this code.
When is an assistant at surgery payable?
CMS payment for an assistant at surgery requires documentation of medical necessity.
How are other same-session procedures paid?
Under the standard multiple procedure reduction, the highest-valued procedure is paid in full and the other procedures are paid at 50%.
Can co-surgeons or a surgical team be reported?
CMS does not permit co-surgeon or team-surgery payment for this code.
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.
7,09263740,,Install spinal shunt,A,,12.31,12.73,NA,12.73,,5.17,30.21,30.21,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09363741,,Install spinal shunt,A,,8.89,9.11,NA,9.11,,3.35,21.35,21.35,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09463744,,Revision of spinal shunt,A,,8.72,9.65,NA,9.65,,3.67,22.04,22.04,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09563746,,Removal of spinal shunt,A,,7.15,9.10,NA,9.10,,3.01,19.26,19.26,0,090,0.11,0.76,0.13,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09664400,,Njx aa&/strd trigeminal nrv,A,,0.73,2.71,,0.48,,0.21,3.65,1.42,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09764405,,Njx aa&/strd gr ocpl nrv,A,,0.92,1.23,,0.25,,0.21,2.36,1.38,0,000,0.00,0.00,0.00,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,09864408,,Njx aa&/strd vagus nrv,A,,0.73,1.55,,0.32,,0.11,2.39,1.16,0,000,0.00,0.00,0.00,2,1,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136