No office rate
Choose 63185 for the one-half-segment extent. Code 63190 describes a rhizotomy extending across more than two segments.
On this page
CMS RVU26D · Effective 2026-10-01
63185 Spinal rhizotomy Medicare reimbursement rates in Wisconsin
Surgical interruption of one or two spinal nerve roots within a one-half-segment extent, reported when the operative treatment targets those roots. Compare 63185 office and facility rates across CMS payment localities in Wisconsin.
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 63185 in Wisconsin?
Wisconsin 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
$1060.15
1 of 1 localities have a supported rate.
Payment area: Wisconsin
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 63185: Limited spinal nerve root rhizotomy
Surgical interruption of one or two spinal nerve roots within a one-half-segment extent, reported when the operative treatment targets those roots.
A surgeon interrupts selected spinal nerve roots to alter nerve signaling, commonly as part of treatment for spasticity or other nerve-mediated symptoms. A neurosurgeon typically performs the operation in a hospital or other facility setting. The operative report should identify the roots treated and describe the extent of the rhizotomy so the one-half-segment service can be distinguished from a broader multisegment procedure.
Report this code when the documented procedure involves one or two spinal nerve roots and the specified one-half-segment extent. The service has a 90-day global period, including 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% multiple-procedure reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 63185
- 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 RVU16.08 · 43%
- Practice expense (office) RVU14.17 · 38%
- Malpractice RVU6.77 · 18%
52
Medicare services in 2024 · #5336 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.
63185 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
No office rate
63185 concerns spinal nerve roots; 63191 concerns the accessory nerve. Select based on the nerve structure actually treated.
No office rate
63185 interrupts spinal nerve roots, while 63170 involves incision of spinal cord tracts. The operative target distinguishes them.
Compare 63185 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
Wisconsin →
Office / nonfacility
Unavailable
Facility
$1060.15
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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 63185 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
7,035
- Code
- 63185
- Physician work
- 16.08
- Practice expense
- 14.17
- Malpractice
- 6.77
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 16.08 | × 1.000 | 16.0800 |
| Practice expense | 14.17 | × 0.958 | 13.5749 |
| Malpractice | 6.77 | × 0.308 | 2.0852 |
| Total RVUs | 31.7400 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Wisconsin$1060.15
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 16.08 | 1 |
| Practice expense | 14.17 | 0.958 |
| Malpractice | 6.77 | 0.308 |
(16.08 × 1 + 14.17 × 0.958 + 6.77 × 0.308) × $33.4009 = $1060.15
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.
63185 billing questions
How does this differ from 63190?
63185 describes a one-half-segment rhizotomy involving one or two spinal nerve roots. Code 63190 is for a rhizotomy extending across more than two segments.
What documentation supports reporting 63185?
The operative report should identify the spinal nerve root or roots treated and establish that the procedure's extent is one-half segment. Documenting only a general diagnosis or the word rhizotomy does not show the extent.
Should modifier 50 be appended for treatment on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code, so modifier 50 is not appropriate.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple-procedure reduction.
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.
7,03263170,,Incise spinal cord tract(s),A,,21.65,16.38,NA,16.38,,9.16,47.19,47.19,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,03363172,,Drainage of spinal cyst,A,,19.27,14.48,NA,14.48,,8.13,41.88,41.88,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,03463173,,Drainage of spinal cyst,A,,23.70,17.09,NA,17.09,,10.02,50.81,50.81,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,03563185,,Incise spine nrv half segmnt,A,,16.08,14.17,NA,14.17,,6.77,37.02,37.02,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,03663190,,Incise spine nrv >2 segmnts,A,,18.42,11.34,NA,11.34,,3.92,33.68,33.68,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,03763191,,Incise spine accessory nerve,A,,18.45,15.00,NA,15.00,,7.77,41.22,41.22,0,090,0.11,0.76,0.13,2,1,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
7,03863197,,Lam w/cordotomy 1stg thrc,A,,23.48,17.01,NA,17.01,,9.92,50.41,50.41,0,090,0.11,0.76,0.13,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,