Fusion · Spine

Lumbar laminectomy at a single vertebral segment that also includes facetectomy and foraminotomy for decompression of the spinal cord, cauda equina, and/or nerve roots — unilateral or bilateral.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,065.49
Total RVUs: 31.9
Global, days: 90
Region: Spine

Drawn from CMSKzanow

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Specify the exact lumbar vertebral segment operated on (e.g., L3-L4, L4-L5) — not just 'lumbar spine'.
Document that all three components were performed: laminectomy, facetectomy, AND foraminotomy — missing any one element does not support 63047.
State whether the facetectomy and foraminotomy were performed unilaterally or bilaterally.
Record the clinical indication, including imaging-confirmed spinal or lateral recess stenosis and the specific nerve root(s) decompressed.
If 63047 is billed with a fusion code at a different interspace, the operative note must clearly identify the separate levels to support modifier 59 or XS.
Document intraoperative findings, including degree of stenosis encountered and any nerve root manipulation, to support medical necessity.

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 RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

63047 covers a posterior lumbar decompression that goes beyond simple laminectomy. Where 63005 removes the lamina for central canal decompression only, 63047 requires all three components: laminectomy, facetectomy (at least partial or medial), and foraminotomy — performed at a single lumbar vertebral segment. The code applies whether the facetectomy and foraminotomy are done unilaterally or bilaterally, and the classic indication is spinal or lateral recess stenosis with nerve root compression.

The 90-day global period covers the operative day, the day-before visit, and all routine post-op care through day 90. Separate E/M billing within that window requires modifier 24 (unrelated E/M) or modifier 25 (same-day significant separate E/M). If additional lumbar segments require the same decompression, report 63048 for each additional segment.

The most critical bundling rule: CMS NCCI policy prohibits separate payment for 63047 with lumbar fusion codes 22630 or 22633 at the same interspace — the decompression is considered included in the fusion work. If the procedures are performed at different interspaces, append modifier 59 or XS to break the edit. Dural leak repair during the same session is also not separately reportable; it is integral to the spinal procedure.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.99
Practice expense RVU	12.03
Malpractice RVU	4.88
Total RVU	31.9
Medicare national rate	$1,065.49
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	$1,065.49
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 63047 get rejected.

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

63047 bundled with 22630 or 22633 at the same interspace without modifier 59/XS — NCCI edit denies the decompression code.
Operative note documents only laminectomy without explicit facetectomy and foraminotomy, causing a downcode to 63005.
Medical necessity denied when preoperative imaging or clinical documentation does not confirm lateral recess or foraminal stenosis requiring foraminotomy.
Modifier 59 or XS used to unbundle 63047 from a fusion code but the operative note fails to identify distinct interspaces, causing payer to reject the modifier.
Global period violations — E/M or injection billed within the 90-day global without modifier 24, 25, or 79 as appropriate.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01What is the difference between 63005 and 63047?

63005 is a laminectomy for central canal decompression only — no facetectomy or foraminotomy. 63047 requires all three: laminectomy plus facetectomy plus foraminotomy. If the lateral recess and foramina are not addressed, 63005 is the correct code.

02Can 63047 and 22630 or 22633 be billed together?

Not at the same interspace. CMS NCCI policy explicitly bundles 63047 into 22630 and 22633 at the same level. If the decompression and fusion are at different interspaces, append modifier 59 or XS to 63047 and ensure the operative note documents the distinct levels.

03How do I bill for decompression at multiple lumbar levels?

Report 63047 for the primary segment and 63048 for each additional segment. Each additional level requires its own documentation confirming laminectomy, facetectomy, and foraminotomy were performed.

04Is the 90-day global period strict for 63047?

Yes. All routine post-op visits, wound checks, and stitch removals through day 90 are bundled. To bill a separate E/M during the global period for an unrelated condition, use modifier 24. For a significant, separately identifiable service on the day of surgery, use modifier 25.

05Is dural leak repair separately billable if it occurs during a 63047 case?

No. Per CMS NCCI policy, repair of an incidental dural leak during a spinal procedure is integral to the primary surgery and is not separately reportable.

06Can two surgeons bill 63047 using modifier 62?

Modifier 62 (co-surgery) is applicable when two surgeons of different specialties each perform distinct portions of the procedure and both document their individual contributions. Both operative reports must support the distinct roles.

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., L4-L5), laterality of the facetectomy and foraminotomy, the specific nerve roots decompressed, and confirmation that all three procedural components — laminectomy, facetectomy, and foraminotomy — were completed. This prevents downcoding to 63005 and supports modifier 59/XS when a fusion at a separate interspace is billed on the same claim.

See how Mira captures CPT 63047 documentation