Thoracic spinal cord or nerve root decompression at one segment through a costovertebral approach, resecting part of the rib head and transverse process to reach the lesion.
- Medicare
- $1,685.74
- Work RVU
- 25.56
- 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 and costovertebral approach with rib and transverse process resection
- Lesion type and location relative to the cord
- Pre-op myelopathy or radicular findings with imaging correlation
- Extent of decompression achieved
- Any fusion or instrumentation and its levels
- Roles of co-surgeons or assistants
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 ↓
63064 is a single-segment thoracic decompression through a costovertebral approach. The surgeon resects the proximal rib and transverse process (a costotransversectomy) to get lateral access to the cord or roots, usually for a central or paracentral thoracic disc herniation or a ventral mass. Each additional thoracic segment done the same way reports add-on 63066.
The approach is the coding hinge. Transpedicular is 63055. A transthoracic anterior discectomy is 63077. Costovertebral means rib resection posterolaterally, and the op note should say so in plain terms. If the rib head removal is only mentioned in passing, a reviewer may push it to a different code.
Global period is 90 days. Instrumented fusion at the same level goes on its own codes. Check current NCCI edits for the pair before adding a modifier. This is a case where co-surgery with modifier 62 or an assistant with 80 is common. Expect payers to request op notes before paying.
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 (25.56) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (50.47) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 25.56 |
| Practice expense RVU | 15.66 |
| Malpractice RVU | 9.25 |
| Total RVU | 50.47 |
| Medicare national rate | $1,685.74 |
| 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 | $1,685.74 |
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 63064 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Approach documented as transpedicular, so 63055 applies
- Anterior transthoracic approach documented, so 63077 applies
- Additional segment billed as a second unit instead of 63066
- Records request not answered before timely filing
- Co-surgeon documentation missing from one surgeon
- Fusion bundling edit without appropriate modifier
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is a costovertebral approach in CPT 63064?
02What add-on code goes with 63064?
03Can fusion be billed with 63064?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's pre-op notes document the myelopathy exam, imaging, and the reason a lateral approach was chosen, which supports a code that payers often review by hand.
See how Mira captures CPT 63064 documentation