Fusion · Spine

Single-level thoracic laminectomy with facetectomy and foraminotomy performed via a posterior approach to decompress neural elements.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,184.40
Total RVUs: 35.46
Global, days: 90
Region: Spine

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must specify the thoracic vertebral level(s) addressed — T1 through T12 — by name, not just 'thoracic spine'.
Document all three components performed: laminectomy, facetectomy, and foraminotomy, with extent of bone and tissue removal described.
Preoperative imaging (MRI or CT) confirming neural compression at the operative thoracic level must be in the record.
Indications for surgery must be documented — symptoms, duration, prior conservative treatment, and neurological findings on exam.
If additional levels were decompressed, each level must be individually documented to support add-on codes 63047 and 63048.
Approach must be described as posterior; an anterior or lateral thoracic approach maps to different codes.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

63046 covers a posterior thoracic decompression at a single vertebral level that combines laminectomy (removal of the lamina), facetectomy (partial or complete removal of the facet joint), and foraminotomy (enlargement of the neural foramen). All three components are bundled into one code — do not unbundle them at the same level. The procedure targets neural compression from conditions such as thoracic disc herniation, stenosis, or ossification of the posterior longitudinal ligament at a single thoracic segment.

The 90-day global period covers the surgery, the day-before visit, and all routine post-op care through day 90. Anything unrelated to the spine decompression billed in that window requires modifier 24 or 25 on the E/M, or modifier 79 for an unrelated surgical procedure. If you need to bill a related return to the OR for a complication, use modifier 78.

If additional thoracic levels are decompressed in the same session, 63047 covers the primary additional level and 63048 covers each level beyond that. Do not report 63046 multiple times for a multilevel thoracic decompression.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.82
Practice expense RVU	12.9
Malpractice RVU	5.74
Total RVU	35.46
Medicare national rate	$1,184.40
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	$1,184.40
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 63046 get rejected.

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

Operative note fails to specify the exact thoracic vertebral level, triggering a documentation insufficiency denial.
All three components (laminectomy, facetectomy, foraminotomy) not explicitly documented — payers deny when only one or two are described.
Missing preoperative imaging report confirming thoracic nerve compression at the billed level.
Medical necessity not established — no documented failure of conservative management prior to surgery.
Code billed multiple times for a multilevel procedure instead of pairing 63046 with add-on codes 63047/63048.
Global period violation — post-op visit billed without modifier 24 when the visit was unrelated to the thoracic decompression.

Frequently asked questions

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

01Can I bill 63046 twice for a two-level thoracic decompression?

No. 63046 covers the first thoracic level. Bill 63047 for the primary additional level and 63048 for each level beyond that. Billing 63046 twice will trigger an NCCI edit.

02What is the global period for 63046?

90 days. All routine post-op visits, wound checks, and stitch removals are bundled. Use modifier 24 for unrelated E/M visits and modifier 79 for unrelated surgical procedures during the global window.

03Does 63046 include the facetectomy and foraminotomy, or do I bill those separately?

They are included. All three components — laminectomy, facetectomy, and foraminotomy — are bundled into 63046 at a single thoracic level. Billing them separately constitutes unbundling.

04If a co-surgeon assists on this case, which modifier applies?

Use modifier 62 if two surgeons of equal standing each perform distinct portions of the procedure and each submits a separate operative report. Use modifier 80 for a standard surgical assistant, or AS if a PA or NP assists.

05Can 63046 be reported with modifier 22 for an unusually complex decompression?

Yes, if the operative complexity significantly exceeds the typical procedure — severe epidural fibrosis, prior surgery at the same level, or unusual anatomical distortion. Document the added time, effort, and circumstances explicitly in the operative note. Without that documentation, payers will deny the modifier 22 upcharge.

06Is there a site-of-service payment difference for 63046?

Yes. HOPD and ASC payments differ meaningfully — see the Site of Service comparison table on this page. The physician's professional fee also differs between facility and non-facility settings per the CMS Physician Fee Schedule 2026.

07What ICD-10 diagnoses are most commonly paired with 63046?

Thoracic disc degeneration with myelopathy or radiculopathy (M51.04, M51.14), thoracic spinal stenosis (M48.04), and thoracic disc herniation with cord compression are the most common pairings. The diagnosis code must match the operative level documented.

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 operative level (e.g., T8-T9), the extent of laminectomy, degree of facetectomy, foraminotomy technique, and neural decompression findings from surgeon dictation. That prevents the most common audit flag for 63046: a generic operative note that confirms surgery happened but doesn't document all three procedural components at a named thoracic level.

See how Mira captures CPT 63046 documentation