Decompression of the thoracic spinal cord or nerve roots through a transpedicular approach at one segment, often for a herniated thoracic disc.
- Medicare
- $1,553.14
- Work RVU
- 22.96
- Global, days
- 90
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Thoracic level treated and transpedicular approach described
- Pathology addressed, such as herniated disc, and its ventral location
- Pre-op myelopathy or radicular findings and MRI or CT correlation
- Extent of pedicle and facet removal
- Any fusion or instrumentation at the same level
- Co-surgeon roles if modifier 62 is used
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
63055 covers a posterior transpedicular approach to decompress the thoracic cord or nerve roots at a single segment. The surgeon removes part of the pedicle and facet to reach a ventral lesion, most often a calcified thoracic disc herniation, without opening the chest. The lumbar version is 63056 and each additional segment in either region reports add-on 63057.
This is a low-volume, high-scrutiny code. Coders sometimes pick it for any thoracic decompression, but a thoracic laminectomy with facetectomy and foraminotomy (63046) or a costovertebral approach (63064) is a different code. The op note must describe the transpedicular route and the ventral decompression.
Global period is 90 days. Instrumented fusion at the same segment is reported with its own fusion and instrumentation codes. Run the pair through current NCCI edits before deciding on any modifier. Two surgeons working as co-surgeons each use modifier 62 and each dictates their own portion. Neuromonitoring by a separate provider is billed by that provider, not the surgeon.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (22.96) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (46.5) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 22.96 |
| Practice expense RVU | 14.98 |
| Malpractice RVU | 8.56 |
| Total RVU | 46.5 |
| Medicare national rate | $1,553.14 |
| 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 | $1,553.14 |
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 63055 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Op note describes a laminectomy, so 63046 applies
- Costovertebral approach documented, so 63064 applies
- Additional segments billed as units instead of 63057
- Co-surgeon claim missing matching documentation from both surgeons
- Fusion codes billed without the op note describing a separate decompression
- Post-op visits billed inside the 90-day global
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is CPT 63055 used for?
02How do you code an additional segment with 63055?
03Is 63055 the same as a thoracic laminectomy?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's notes capture the thoracic myelopathy exam and imaging review that justify a transpedicular decompression, so the pre-op record matches the op note.
See how Mira captures CPT 63055 documentation