No office rate
Both address nonneoplastic extradural lesions, but 63267 is for the lumbar region; 63268 is for the sacral region.
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CMS RVU26D · Effective 2026-10-01
63268 Spinal lesion excision Medicare reimbursement rates in Missouri
Reports laminectomy-based removal or evacuation of a nonneoplastic lesion outside the dura in the sacral spinal canal. Compare 63268 office and facility rates across CMS payment localities in Missouri.
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 63268 in Missouri?
Missouri has 3 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 3 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1377.26–$1432.71
3 of 3 localities have a supported rate.
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.
Where 63268 pays more and less in Missouri
Spine surgery
About 63268: Sacral extradural lesion excision
Reports laminectomy-based removal or evacuation of a nonneoplastic lesion outside the dura in the sacral spinal canal.
A neurosurgeon or orthopedic spine surgeon uses a laminectomy approach to remove or evacuate a nonneoplastic lesion in the sacral spinal canal that lies outside the dura. Examples include an extradural abscess or hematoma. The operative report should establish the sacral level, extradural location, and nonneoplastic nature of the lesion, as well as the work performed to remove or evacuate it.
Choose this code for the sacral level and extradural, nonneoplastic lesion type; a lesion inside the dura or a neoplasm follows a different code pathway. This major surgery has 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 the others at 50%. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeons are paid only with supporting documentation, and team surgery is not permitted.
CMS billing rules for 63268
- 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 RVU19.52 · 45%
- Practice expense (office) RVU15.88 · 36%
- Malpractice RVU8.24 · 19%
77
Medicare services in 2024 · #5091 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.
63268 compared with similar codes
Office rates for Missouri, from the same CMS release.
No office rate
Use 63268 for an extradural sacral lesion and 63273 when the sacral lesion is intradural and extramedullary.
No office rate
Both concern sacral extradural lesions, but 63278 is for a neoplasm; 63268 is for a nonneoplastic lesion.
No office rate
63283 addresses a sacral lesion that is both intradural and extramedullary and is treated through the neoplasm biopsy or excision pathway.
Compare 63268 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.
3 of 3 payment localities
Metropolitan Kansas City →
Office / nonfacility
Unavailable
Facility
$1418.93
Metropolitan St. Louis →
Office / nonfacility
Unavailable
Facility
$1432.71
Rest Of Missouri →
Office / nonfacility
Unavailable
Facility
$1377.26
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63268 billing questions
How is this code distinguished from the lumbar version?
This code is for the sacral region. Use the lumbar sibling when the treated extradural lesion is at a lumbar level.
Does this code cover an intradural lesion?
No. It describes treatment of a lesion outside the dura; an intradural lesion belongs to a different code pathway.
Can it be reported for an extradural neoplasm?
This code is for a nonneoplastic lesion. The operative documentation should support the lesion type as well as its sacral level and extradural location.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can modifier 50 be used for bilateral treatment?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How are multiple procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures are paid at 50%. An assistant at surgery may be paid; co-surgery requires supporting documentation.
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.
7,04363265,,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
7,04763270,,Excise intrspinl lesion crvl,A,,29.06,19.23,NA,19.23,,12.28,60.57,60.57,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04863271,,Excise intrspinl lesion thrc,A,,29.17,19.03,NA,19.03,,12.05,60.25,60.25,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,04963272,,Excise intrspinl lesion lmbr,A,,26.81,17.42,NA,17.42,,10.54,54.77,54.77,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00