Billing code 63278: Spinal lesion surgeryMedicare rate & RVUs in Oregon
Reports posterior surgical access to biopsy or remove a suspected or known neoplasm located outside the dura in the sacral spinal canal.
CMS doesn’t publish an office rate for 63278 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 63278 covers
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.
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 63278 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,574.62 |
| Rest Of Oregon | Unavailable | $1,486.84 |
How the 63278 rate is calculated
Each of 63278’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 · 63278
RVUs × geographic indexes × conversion factor
Work21.57
21.57 RVUs× 1.000 GPCI
Practice expense16.60
16.60 RVUs× 1.000 GPCI
Malpractice9.12
9.12 RVUs× 1.000 GPCI
Adjusted RVUs
47.2900
Conversion factor
$33.4009
Medicare rate
$1,579.53
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 63278
63278 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 63278
Spinal lesion surgery
| 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 · 63278
Spinal lesion surgery
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
63278 without 51 · national facility
$1,579.53
Spinal lesion surgery
63278-51 · Second procedure: 50%
$789.77
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%).
63278 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 63277Spinal lesion surgery
- Both address extradural spinal neoplasms, but 63277 is for the lumbar region and 63278 is for the sacral region. Use the documented operative level.
- 63283Spinal tumor surgery
- Both address sacral neoplasms, but 63283 is for a lesion within the dura. This code is for a lesion outside the dura.
- 63268Spinal lesion excision
- This code is for biopsy or removal of a sacral extradural neoplasm; 63268 is for a sacral extradural lesion other than a neoplasm.
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 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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