Surgical · Spine

Add-on code for each additional vertebral body resection segment performed via transperitoneal or retroperitoneal approach with spinal cord, cauda equina, or nerve root decompression in the lower thoracic, lumbar, or sacral spine — reported after the primary corpectomy code 63090.

Verified May 8, 2026 · 8 sources ↓

Medicare: $157.99
Work RVU: 2.95
Global, days
Region: Spine

Drawn from CMSMedtronicUhcproviderLdhNIH

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Identify each additional vertebral level by anatomic designation (e.g., L2, L3) in the operative note
Name the surgical approach explicitly — transperitoneal or retroperitoneal — not just 'anterior approach'
Document decompressive work at each segment: spinal cord, cauda equina, or specific nerve root(s) addressed
Confirm the primary procedure code (63090 or applicable primary) is reported on the same claim
Record pre-operative imaging that supports pathology at each additional segment requiring corpectomy
If two surgeons present, each surgeon must dictate a separate operative report with justification for co-surgery

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 76 Repeat, same physician 77 Repeat, another physician 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 63091 is an add-on code (ZZZ global) reported for each additional vertebral body segment resected via a transperitoneal or retroperitoneal approach with decompression of the spinal cord, cauda equina, or nerve roots at the lower thoracic, lumbar, or sacral levels. It is never reported alone — it always accompanies the primary single-segment corpectomy code 63090. Each additional segment beyond the first requires a separate line with 63091.

Because 63091 carries a ZZZ global period, it inherits the global period of the primary procedure it supports. Anesthesia, hospital, and assistant surgeon roles follow the same rules as the primary code. When two surgeons perform distinct portions of the procedure, modifier 62 applies to both the primary and add-on codes. Complex multi-surgeon vertebrectomies may also support modifier 66, but payer-specific negotiation is required for that pricing — do not assume a standard fee schedule rate applies.

Documentation must clearly identify each additional segment by level, the approach used, and the decompressive work performed at each level. Operative notes that describe only a single level or omit the surgical approach name routinely trigger payer downcoding or bundling of multiple 63091 units. UnitedHealthcare and some state Medicaid programs (including Louisiana) require medical records to confirm segment-by-segment necessity before authorizing multiple units.

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 (2.95) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (4.73) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.95
Practice expense RVU	0.93
Malpractice RVU	0.85
Total RVU	4.73
Medicare national rate	$157.99
Global period	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	$157.99

Common denial reasons

The recurring reasons claims for CPT 63091 get rejected.

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

Reported without the required primary procedure code 63090 on the same claim
Operative note documents only a single vertebral level, making additional units unsupported
Payer bundles multiple units of 63091 when segment-by-segment medical necessity is not independently documented
Approach not specified by name in the operative note, triggering a coding audit or downcoding
Modifier 62 missing when two co-surgeons each dictated separate reports for distinct portions of the procedure

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can 63091 be billed without 63090 on the same claim?

No. 63091 is an add-on code and must always be listed in addition to the primary single-segment corpectomy code 63090. Submitting 63091 as a standalone code will result in denial.

02How many units of 63091 can be reported?

One unit per additional segment beyond the first. If three vertebral bodies are resected, report 63090 for the first segment and two units of 63091 for the second and third. Each unit requires segment-level documentation supporting medical necessity.

03Does modifier 51 apply to 63091?

No. Add-on codes are exempt from modifier 51 reduction. Do not append modifier 51 to 63091 — it should appear on the claim without it, following the primary procedure code.

04When should modifier 62 be used with 63091?

When two surgeons each perform distinct portions of the corpectomy at the additional segment, both report 63091 with modifier 62. Each surgeon must document their specific role and the medical necessity for co-surgery. CMS reimburses each co-surgeon at 62.5% of the fee schedule amount.

05What is the global period for 63091, and how does it affect billing?

63091 carries a ZZZ global period, meaning it has no independent global period and instead falls under the global period of the primary procedure it accompanies. Post-op billing follows 63090's global period rules.

06Is 63091 payable in the ASC or HOPD setting?

Per CMS 2026 data, there is no separate ASC or HOPD facility payment for 63091 — it is a physician-side add-on code. Confirm facility-specific reimbursement with the applicable facility contract.

07Does UnitedHealthcare require prior authorization for 63091?

UHC's spinal decompression policies require medical records documentation to confirm segment-by-segment necessity. Pre-authorization requirements vary by plan; verify eligibility and PA status before scheduling multi-level corpectomy cases.

Sources & references

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

Mira Scribe

Mira's AI scribe captures each additional vertebral level by name, the approach (transperitoneal vs. retroperitoneal), and the specific neural structure decompressed at each segment directly from surgeon dictation. This prevents the most common 63091 denial: an operative note that documents only one level or omits the approach, causing payers to collapse multiple add-on units into a single billable segment.

See how Mira captures CPT 63091 documentation