Surgical · Spine

Laminectomy combined with rhizotomy (nerve root severing) performed across more than two spinal segments in a single surgical session.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,124.94
Work RVU: 18.42
Global, days: 90
Region: Spine

Drawn from CMSFastrvuMdclarityGenhealth

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 identify each spinal segment by level (e.g., L2, L3, L4) with explicit count confirming more than two segments treated.
Document the laminectomy component separately from the rhizotomy — note which lamina was removed and which nerve roots were sectioned.
Specify whether segments are contiguous or non-contiguous; non-contiguous regions accessed via separate incisions require independent documentation per NCCI policy.
Record the clinical indication for rhizotomy (e.g., intractable spasticity, chronic neuropathic pain) and prior failed conservative treatments.
Note patient positioning, approach used, and any intraoperative neurophysiological monitoring if applicable.
Confirm that fluoroscopy use, if present, is documented as integral to the procedure rather than separately billed guidance.

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon 62 Co-surgeons

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 63190 describes a laminectomy with rhizotomy spanning more than two spinal segments. The surgeon removes laminar bone to decompress the neural canal, then severs specific dorsal nerve roots to interrupt pain signaling — typically for intractable spasticity or chronic neuropathic pain unresponsive to conservative management. Because the code requires more than two segments, it represents a more extensive resection than its sibling codes in the 63180–63190 family.

The 90-day global period covers the day-before preoperative visit, the day of surgery, and all routine post-op care through day 90. E/M visits for new problems unrelated to the rhizotomy during that window require modifier 24. If a second surgery is needed within the global for a related complication, use modifier 78; for an entirely unrelated procedure, use modifier 79.

Fluoroscopy used intraoperatively is integral to most open spinal procedures and is not separately reportable with 63190 per NCCI policy — don't stack 76000 onto this claim. If the procedure spans non-contiguous spinal regions accessed through separate incisions, NCCI allows reporting a primary code per region; document each region and incision independently in the operative note.

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 (18.42) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (33.68) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	18.42
Practice expense RVU	11.34
Malpractice RVU	3.92
Total RVU	33.68
Medicare national rate	$1,124.94
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	$1,124.94

Common denial reasons

The recurring reasons claims for CPT 63190 get rejected.

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

Segment count not explicitly documented — operative note states 'multilevel' without naming each level, failing the >2 segment threshold.
Rhizotomy component underdocumented — note describes laminectomy only, giving reviewers grounds to downcode to a decompression-only code.
Fluoroscopy billed separately as 76000 alongside 63190, triggering an NCCI bundling edit and automatic denial of the imaging line.
Missing medical necessity documentation — no record of failed conservative treatment or inadequate justification for nerve root sectioning.
Global period violation — post-op E/M visit billed without modifier 24 when the visit was flagged as routine follow-up within the 90-day window.

Frequently asked questions

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

01What is the minimum number of segments required to bill 63190?

More than two spinal segments must be treated. Procedures involving exactly one or two segments fall under different codes in the 63180–63185 range. Your operative note must name each level — 'multilevel' alone won't satisfy the threshold on audit.

02Can 63190 be billed at a hospital outpatient or ASC setting?

63190 carries a 'C' status indicator for ASC payment, meaning it is contractor-priced and not assigned a standard ASC payment rate under the national fee schedule. Verify reimbursement directly with individual payers and facilities before scheduling.

03Is fluoroscopy separately billable with 63190?

No. Per NCCI policy, fluoroscopy (CPT 76000) is integral to open spinal procedures and must not be reported separately with 63190. Doing so will trigger a bundling edit.

04How should you bill if the rhizotomy spans non-contiguous spinal regions through separate incisions?

NCCI allows reporting a primary procedure code per non-contiguous region when separate skin incisions are used. Document each region, each incision, and each set of nerve roots independently. Modifier 59 may be needed to distinguish the distinct services.

05When is modifier 22 appropriate with 63190?

Use modifier 22 when operative complexity substantially exceeds what the code normally requires — for example, severe epidural fibrosis from prior surgery, anatomical anomalies, or significantly prolonged operating time. Attach a cover letter explaining the added work; without it, payers routinely ignore modifier 22.

06What does the 90-day global period include for 63190?

It covers the day-before preoperative visit, the operative day, and all routine post-op care through day 90. Unrelated E/M visits in that window need modifier 24. A related return to the OR needs modifier 78; an unrelated procedure needs modifier 79.

07Can a co-surgeon bill 63190 with modifier 62?

Modifier 62 applies when two surgeons of different specialties each perform distinct portions of a procedure requiring their separate skills. If co-surgery is medically necessary and documented, both surgeons report 63190-62. Each operative note must describe that surgeon's distinct contribution.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the specific spinal levels addressed (e.g., L2–L5), explicitly tallies the segment count, and records which nerve roots were sectioned versus which laminae were resected. It also flags the clinical indication and prior failed treatments in the note. This prevents the most common denial: an operative report that says 'multilevel' without naming levels, which auditors use to challenge whether the >2-segment threshold was actually met.

See how Mira captures CPT 63190 documentation