No office rate
Both address extradural spinal neoplasms, but 63277 is for the lumbar region and 63278 is for the sacral region. Use the documented operative level.
On this page
CMS RVU26D · Effective 2026-10-01
63278 Spinal lesion surgery Medicare reimbursement rates in Ohio
Reports posterior surgical access to biopsy or remove a suspected or known neoplasm located outside the dura in the sacral spinal canal. Compare 63278 office and facility rates across CMS payment localities in Ohio.
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 63278 in Ohio?
Ohio 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
$1533.73
1 of 1 localities have a supported rate.
Payment area: Ohio
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 63278: Sacral extradural spinal lesion surgery
Reports posterior surgical access to biopsy or remove a suspected or known neoplasm located outside the dura in the sacral spinal canal.
A spine surgeon, commonly a neurosurgeon or orthopedic spine surgeon, uses a posterior approach and removes bone as needed to reach a lesion in the sacral spinal canal, outside the dura. The service includes obtaining tissue for diagnosis or removing the lesion; it is performed in an operating room, typically in a hospital setting. The sacral location and extradural position distinguish this service from procedures for lesions at other spinal levels or within the dura.
Select the code when the operative findings and report support a sacral extradural neoplasm and document whether tissue was sampled or the lesion removed. The 90-day global period includes 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 other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this sacral service. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery billing is not permitted.
CMS billing rules for 63278
- 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 RVU21.57 · 46%
- Practice expense (office) RVU16.60 · 35%
- Malpractice RVU9.12 · 19%
56
Medicare services in 2024 · #5285 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.
63278 compared with similar codes
Office rates for Ohio, from the same CMS release.
No office rate
Both address sacral neoplasms, but 63283 is for a lesion within the dura. This code is for a lesion outside the dura.
No office rate
This code is for biopsy or removal of a sacral extradural neoplasm; 63268 is for a sacral extradural lesion other than a neoplasm.
Compare 63278 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
Ohio →
Office / nonfacility
Unavailable
Facility
$1533.73
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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 63278 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
7,054
- Code
- 63278
- Physician work
- 21.57
- Practice expense
- 16.60
- Malpractice
- 9.12
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 21.57 | × 1.000 | 21.5700 |
| Practice expense | 16.60 | × 0.913 | 15.1558 |
| Malpractice | 9.12 | × 1.008 | 9.1930 |
| Total RVUs | 45.9188 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Ohio$1533.73
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 21.57 | 1 |
| Practice expense | 16.6 | 0.913 |
| Malpractice | 9.12 | 1.008 |
(21.57 × 1 + 16.6 × 0.913 + 9.12 × 1.008) × $33.4009 = $1533.73
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.
63278 billing questions
How does this differ from the lumbar code 63277?
The lesion’s spinal level determines the choice: 63278 is for the sacral region, while 63277 is for the lumbar region. The operative report should establish the treated level.
When should the intradural sacral code be used instead?
Use the intradural code, 63283, when the lesion is within the dura. This code is for a lesion outside the dura; document the lesion’s relationship to the dura.
Does the procedure include the bone removal needed for access?
The service describes surgical access to the extradural lesion through a posterior approach, with bone removal as needed. Document the exposure and work performed in the operative report.
Can biopsy and excision be reported separately for the same lesion?
The code covers the biopsy-or-removal service for the sacral extradural neoplasm. Do not report separate instances of this code for sampling and then removing the same lesion during the same operation.
What documentation supports an assistant or co-surgeon?
An assistant at surgery may be paid. Co-surgeon payment requires supporting documentation describing the distinct work and participation of each surgeon.
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.
7,05163275,,Bx/exc xdrl spine lesn crvl,A,,25.21,16.86,NA,16.86,,9.78,51.85,51.85,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05263276,,Bx/exc xdrl spine lesn thrc,A,,25.05,16.84,NA,16.84,,9.82,51.71,51.71,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05363277,,Bx/exc xdrl spine lesn lmbr,A,,21.83,15.06,NA,15.06,,8.09,44.98,44.98,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05463278,,Bx/exc xdrl spine lesn scrl,A,,21.57,16.60,NA,16.60,,9.12,47.29,47.29,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05563280,,Bx/exc idrl spine lesn crvl,A,,29.53,19.94,NA,19.94,,12.28,61.75,61.75,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,05663281,,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
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703