Surgical · Spine

Lumbar laminotomy or hemilaminectomy performed as a reexploration at a single interspace, including nerve root decompression with partial facetectomy, foraminotomy, and/or herniated disc excision at a previously operated level.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,219.80
Total RVUs: 36.52
Global, days: 90
Region: Spine

Drawn from CMSMedtronicBeckersascMdclarityPayerprice

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Explicit documentation that the operative interspace was previously surgically entered — the reexploration designation hinges on this
Identification of the specific lumbar interspace treated (e.g., L4-L5, L5-S1)
Description of each component performed: laminotomy extent, partial facetectomy, foraminotomy, and/or disc excision
Imaging (MRI or CT) correlating symptoms and surgical findings to the reoperated level
Operative note documenting scar tissue encountered, nerve root decompression achieved, and approach side (left vs. right or bilateral)
Prior operative report or reference confirming previous surgery at the same interspace to support medical necessity for reexploration

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 51 Multiple procedures 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

63042 covers a reexploration laminotomy at a single lumbar interspace — meaning the operative site has been previously surgically entered. The procedure includes partial removal of the lamina, decompression of one or more nerve roots, partial facetectomy, foraminotomy, and/or disc excision as needed. The reexploration designation is what distinguishes this code from primary lumbar decompression codes; if there is no prior surgery at that interspace, 63042 does not apply.

The 90-day global period means all routine post-op care through day 90 is bundled. Unrelated E/M visits in that window require modifier 24; a new, unrelated procedure requires modifier 79. Per the CMS NCCI 2026 policy manual, 63042 cannot be separately reported alongside certain other spinal decompression codes at the same interspace — review NCCI edits before stacking decompression codes. For additional lumbar interspaces beyond the first, report add-on code 63044; do not report 63042 twice.

Effective January 1, 2026, CMS added over 100 spine procedures to the ASC Covered Procedures List, making 63042 payable in the ASC setting. Site-of-service choice now directly affects reimbursement — HOPD and ASC facility rates differ substantially (see the Site of Service comparison on this page). The code is billed predominantly by orthopedic surgeons and neurosurgeons.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	18.29
Practice expense RVU	12.73
Malpractice RVU	5.5
Total RVU	36.52
Medicare national rate	$1,219.80
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$1,219.80
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 63042 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing evidence of prior surgery at the same interspace — payers deny 63042 when records don't confirm reexploration status
Bundling with primary lumbar decompression codes billed same-day at the same level without an NCCI-compliant modifier
Reporting 63042 twice for multiple interspaces instead of using 63042 for the first interspace and add-on 63044 for additional levels
Lack of imaging documentation linking the reoperated level to the patient's current symptoms
Site-of-service mismatch between the place of service billed and the facility type where the procedure was actually performed

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What makes 63042 a reexploration code versus a primary lumbar laminotomy code?

The operative interspace must have been previously surgically entered. If this is a first-time surgery at that level, use the appropriate primary decompression code instead. Document the prior surgery explicitly in the operative note.

02How do I code a reexploration laminotomy at two lumbar interspaces?

Report 63042 for the first lumbar interspace and add-on code 63044 for each additional lumbar interspace. Do not report 63042 twice.

03Can 63042 be billed in an ASC in 2026?

Yes. Effective January 1, 2026, CMS added this procedure to the ASC Covered Procedures List. Check the Site of Service comparison on this page for the ASC vs. HOPD rate difference.

04What modifier applies if the surgeon performs an unrelated procedure during the 90-day global period?

Use modifier 79 for an unrelated procedure performed during the global period. Modifier 78 is reserved for an unplanned return to the OR for a complication related to the original procedure.

05Is a bilateral lumbar reexploration laminotomy reportable with modifier 50?

Yes. If decompression is performed on both sides of the same interspace in the same session, append modifier 50. Document bilateral nerve root involvement and decompression in the operative note.

06Does 63042 include fluoroscopy for level confirmation?

Intraoperative fluoroscopy used solely for level localization is generally considered bundled. Per NCCI policy, if imaging guidance is included in the code descriptor or procedural work, it cannot be separately reported.

07Can a PA or NP serving as surgical assistant bill under 63042?

The assistant's service is reported with modifier AS on the claim. The surgeon bills 63042 without that modifier; the assistant's entity bills 63042-AS separately.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the surgeon's dictation of the prior operative level, the specific lumbar interspace treated, each decompressive component performed (laminotomy extent, partial facetectomy, foraminotomy, disc excision), the approach side, and the presence of epidural scar encountered during reexploration. That documentation directly supports the reexploration designation and prevents denials from payers challenging whether the site had been previously operated.

See how Mira captures CPT 63042 documentation