Billing code 63042: Lumbar decompressionMedicare rate & RVUs in Oregon
Reports repeat surgery at one lumbar level to relieve nerve-root compression through a limited bone opening, with related facet, foramen, or disc work as indicated.
CMS doesn’t publish an office rate for 63042 in Oregon.
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 63042 covers
A spine surgeon uses this service to revisit a previously operated lumbar level and relieve recurrent nerve-root compression. The work may include a limited opening in the posterior vertebral bone, partial facet removal, widening the nerve-root exit, and removal of herniated disc material when needed. A typical clinical situation is recurrent leg pain from nerve-root compression at a level treated surgically before. The code represents one lumbar level; additional re-exploration levels are addressed separately when supported.
Report this code when the operative report supports re-exploration at a single lumbar level and describes the nerve-root decompression performed. The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Bilateral reporting with modifier 50 is paid at 150%. An assistant at surgery may be paid, and co-surgeons are permitted; 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 63042 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,229.74 |
| Rest Of Oregon | Unavailable | $1,163.54 |
How the 63042 rate is calculated
Each of 63042’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 · 63042
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 18.29Practice expense 12.73Malpractice 5.50
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 63042
63042 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 63042
Lumbar 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) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 2 | Permitted. |
| 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 · 63042
Lumbar 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 50 · payment effect
With and without the modifier
63042 without 50 · national facility
$1,219.80
Lumbar decompression
63042-50 · Bilateral: 150%
$1,829.70
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
63042 compared with similar codes
Compare codes
63042 vs 63030 vs 63044 vs 63047: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 63030Lumbar decompression
- Both describe single-level lumbar nerve-root decompression, but 63042 is for re-exploration at a previously operated level; 63030 is the non-re-exploration counterpart.
- 63044Laminotomy addl lumbar
- 63044 represents an additional lumbar level during re-exploration. Use 63042 for the single level, not for each additional level.
- 63047Lumbar decompression
- 63047 describes lumbar decompression with laminectomy, facetectomy, and foraminotomy. Choose based on the procedure performed and the code’s scope, rather than treating it as the re-exploration code.
63042 billing questions
How does this differ from 63030?
63042 is for re-exploration at a previously operated lumbar level. 63030 is used for the corresponding single-level lumbar decompression when it is not a re-exploration.
Can the code include disc removal or foraminotomy?
Yes. The work may include partial facet removal, widening the nerve-root exit, or excision of herniated disc material as part of the decompression. The operative report should describe the work performed.
What supports reporting a re-exploration?
Document the previously operated lumbar level, the recurrent nerve-root compression being treated, and the decompression performed at that level. The record should make clear that the procedure revisits the prior operative site.
How is another lumbar level reported?
For an additional lumbar re-exploration level, consider 63044 when its requirements are met. The operative documentation should identify the additional level and the work performed there.
What payment rules apply to the surgical session?
This code has a 90-day global period, and same-session multiple procedures are subject to the standard reduction after the highest-valued procedure. Modifier 50 bilateral reporting is paid at 150%; an assistant may be paid and co-surgeons are permitted.
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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