No office rate
Use 63055 for a thoracic segment and 63056 for a lumbar segment when the transpedicular decompression approach is performed.
On this page
CMS RVU26D · Effective 2026-10-01
63055 Spinal decompression Medicare reimbursement rates in Rhode Island
Reports posterior transpedicular decompression at one thoracic spinal segment, commonly for a disc herniation compressing the cord or nerve roots. Compare 63055 office and facility rates across CMS payment localities in Rhode Island.
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 63055 in Rhode Island?
Rhode Island 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
$1553.35
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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.
Spine surgery
About 63055: Thoracic transpedicular spinal decompression
Reports posterior transpedicular decompression at one thoracic spinal segment, commonly for a disc herniation compressing the cord or nerve roots.
A spine surgeon, commonly an orthopedic spine surgeon or neurosurgeon, uses a posterior transpedicular route to reach and decompress neural structures at one thoracic segment. A typical situation is a thoracic disc herniation compressing the spinal cord or nerve roots when this route is selected for access. Medicare claims for this service are predominantly for facility procedures.
Report one unit for the documented thoracic segment treated with this approach. The operative report should identify the spinal level, transpedicular route, compressive pathology, and decompression performed. Code 63057 is the add-on for each additional segment when its requirements are met. This major surgery has a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple procedure reduction. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 63055
- 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 RVU22.96 · 49%
- Practice expense (office) RVU14.98 · 32%
- Malpractice RVU8.56 · 18%
1.3K
Medicare services in 2024 · #2784 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.
63055 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
63055 reports the primary thoracic segment; 63057 is the add-on for each additional segment and is not reported alone.
No office rate
Both address thoracic spinal cord decompression, but 63064 describes a costovertebral route rather than the transpedicular route represented by 63055.
No office rate
63046 describes thoracic decompression through a laminectomy, facetectomy, and foraminotomy approach; 63055 is selected for the transpedicular approach.
Compare 63055 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$1553.35
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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 63055 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
7,012
- Code
- 63055
- Physician work
- 22.96
- Practice expense
- 14.98
- Malpractice
- 8.56
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 22.96 | × 1.019 | 23.3962 |
| Practice expense | 14.98 | × 1.033 | 15.4743 |
| Malpractice | 8.56 | × 0.892 | 7.6355 |
| Total RVUs | 46.5061 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1553.35
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 22.96 | 1.019 |
| Practice expense | 14.98 | 1.033 |
| Malpractice | 8.56 | 0.892 |
(22.96 × 1.019 + 14.98 × 1.033 + 8.56 × 0.892) × $33.4009 = $1553.35
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.
63055 billing questions
How is this different from code 63056?
Both describe transpedicular decompression, but 63055 is for a thoracic segment and 63056 is for a lumbar segment. Select the code based on the treated spinal region.
When can code 63057 be reported with 63055?
Code 63057 is the add-on for each additional segment when more than one segment is treated. Document each level and the work performed; do not use it as a standalone primary procedure.
Should modifier 50 be used for bilateral decompression?
No. CMS identifies bilateral adjustment as inappropriate for this code. Report the service based on the documented segment and applicable coding instructions.
What documentation supports reporting 63055?
The operative report should establish the thoracic level, transpedicular approach, compressive condition, and decompression performed. It should also distinguish any additional segment treated.
How does the 90-day global period affect postoperative billing?
The global period includes the day-before preoperative visit and 90 days of related postoperative care. The related care is included in the surgical global period.
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.
7,00963051,,C-laminoplasty w/graft/plate,A,,24.87,14.73,NA,14.73,,7.55,47.15,47.15,0,090,0.11,0.76,0.13,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,01063052,,Lam facetc/frmt arthrd lum 1,A,,4.14,1.39,NA,1.39,,1.35,6.88,6.88,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,01163053,,Lam factc/frmt arthrd lum ea,A,,3.69,1.23,NA,1.23,,1.21,6.13,6.13,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,01263055,,Decompress spinal cord thrc,A,,22.96,14.98,NA,14.98,,8.56,46.50,46.50,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,01363056,,Decompress spinal cord lmbr,A,,21.31,13.59,NA,13.59,,7.16,42.06,42.06,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,01463057,,Decompress spine cord add-on,A,,5.12,1.73,NA,1.73,,1.76,8.61,8.61,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,01563064,,Decompress spinal cord thrc,A,,25.56,15.66,NA,15.66,,9.25,50.47,50.47,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537