Laminectomy-based removal of an extradural lesion located in the lumbar spine, accessing the intraspinal space by resecting the posterior bony arch.

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

• Specify the lumbar level(s) operated on (e.g., L3-L4) — generic 'lumbar' without level identification is an audit flag.
• Identify the lesion type by name (synovial cyst, epidural hematoma, abscess, tumor deposit, etc.) with pathology or intraoperative confirmation noted.
• Describe the laminectomy approach explicitly — partial vs. complete laminectomy, bone removal extent, and laterality if applicable.
• Document extradural location of the lesion; intradural involvement changes the code family entirely and must be addressed or excluded.
• Include pre-op imaging correlation (MRI or CT) linking the identified lesion to the operative level.
• Record whether the lesion was adherent to the dura, and if so, how dural integrity was managed — critical for distinguishing extradural from intradural codes.
• Note any neurological status pre- and post-decompression to support medical necessity for this high-complexity procedure.

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 8 cited references ↓

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

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

Common denial reasons

The recurring reasons claims for CPT 63267 get rejected.

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

• Billed in an outpatient or ASC setting — 63267 is CMS inpatient-only; site-of-service mismatch results in automatic non-payment under HOPD rules.
• Diagnosis code doesn't support an extradural intraspinal lesion — using a herniated disc ICD-10 code (e.g., M51.x) when the procedure is for a cyst or mass triggers medical necessity review.
• Operative note says 'standard laminectomy approach' without naming the lesion type or confirming extradural position — payers and auditors cannot validate the correct code.
• 69990 billed separately for operating microscope use — NCCI bundles this into 63267 for Medicare; unbundled claims deny without prior MAC-level justification.
• Global period violation — post-op E/M visits billed within 90 days without modifier 24 or 25 are denied as included services.
• Insufficient imaging or pathology documentation to confirm a distinct resectable lesion rather than routine decompressive laminectomy.