Surgical · Spine

Surgical implantation of a permanent laminectomy electrode array for spinal cord stimulation, performed via open exposure of the epidural space.

Verified May 8, 2026 · 5 sources ↓

Medicare: $838.70
Total RVUs: 25.11
Global, days: 90
Region: Spine

Drawn from CMSMemberAsra

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Confirm the patient completed a successful SCS trial prior to permanent implant (trial-to-permanent ratio is subject to post-payment review)
Operative note must specify open surgical approach, laminectomy or laminotomy level(s), and epidural electrode placement
Radiologic imaging (fluoroscopy or equivalent) confirming proper lead placement must be in the record, even though it is not billed separately
Diagnosis supporting chronic intractable pain must be documented and linked to covered ICD-10 codes per the applicable LCD
Document that the procedure was performed in an ASC, outpatient hospital, or inpatient hospital — office setting is not covered for 63655
If replacing a percutaneous lead with a paddle lead, document removal of prior lead (63661) and rationale for conversion in the operative note

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

63655 covers permanent placement of a paddle (laminectomy) electrode array for spinal cord stimulation. Unlike percutaneous lead placement (63650), this code requires open surgical exposure — a laminectomy or laminotomy — to position the electrode array in the epidural space. It is billed once per patient per lifetime under Medicare and must be performed in an ASC, outpatient hospital, or inpatient hospital; it cannot be billed in an office setting.

Fluoroscopy is inherent to the procedure. NCCI edits prohibit billing imaging guidance separately with 63655 — don't append a fluoroscopy code. Similarly, code 95970 (electronic analysis/interrogation of the neurostimulator) is integral to lead implantation and cannot be reported separately on the same date. The 90-day global period covers all routine post-operative management through day 90; unrelated E/M services in that window require modifier 79 or 24 as appropriate.

When a permanent percutaneous lead is removed (63661) and replaced with a new paddle lead via fresh laminectomy at the same or different spinal level, 63655 is reported alongside 63661 — NCCI edits allow this combination without a modifier. For non-Medicare payers billing multiple leads, contact the payer directly; Medicare MUE allows only 1 unit of 63655 per date of service.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.65
Practice expense RVU	10.63
Malpractice RVU	3.83
Total RVU	25.11
Medicare national rate	$838.70
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	$838.70
HOPD (APC 5464) Hospital outpatient department	$19,820.31
ASC (PI J8) Ambulatory surgical center (freestanding)	$14,405.66

Common denial reasons

The recurring reasons claims for CPT 63655 get rejected.

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

Billing site of service as office — 63655 is not payable in the office under Medicare
Unbundling fluoroscopy (e.g., 77003) separately — NCCI edits bundle imaging guidance into 63655
Submitting more than 1 unit on the same date of service — Medicare MUE is 1 unit; excess units will deny
Missing or inadequate documentation of a successful prior SCS trial, triggering medical necessity denial
Billing 95970 separately on the same date — electronic analysis is integral to lead implantation and not separately payable
Low trial-to-permanent implant ratio (below 50%) flagging the claim for post-payment review and potential recoupment

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 63655 be billed in an office setting?

No. Medicare explicitly requires 63655 to be performed in an ASC, outpatient hospital, or inpatient hospital. Claims billed with a place-of-service code for office will deny.

02Can fluoroscopy be billed separately with 63655?

No. Fluoroscopy is included in the published code vignette and NCCI edits prohibit separate billing of imaging guidance alongside 63655. Do not append a fluoroscopy code.

03How many times can 63655 be billed per patient?

Once per patient per lifetime under Medicare. The MUE also restricts billing to 1 unit per date of service. Non-Medicare payers may differ — verify with each payer before billing additional units.

04What happens if the trial-to-permanent implant ratio falls below 50%?

CMS billing and coding articles flag physicians with a ratio below 50% for post-payment review. Auditors will request patient selection criteria, imaging confirming lead placement, and medical necessity documentation. Failure to provide it results in recoupment.

05Can 63655 and 63661 be billed together when converting a percutaneous lead to a paddle lead?

Yes. When an existing percutaneous lead is removed (63661) and replaced with a new paddle lead via laminectomy (63655) at the same or different level, both codes are reportable and NCCI edits allow the combination without a modifier.

06Is 95970 separately billable on the same day as 63655?

No. Electronic analysis of the implanted neurostimulator (95970) is integral to lead implantation. NCCI edits prohibit reporting it separately on the same date of service as 63655.

07What modifier applies if a surgeon performs an unrelated procedure during the 90-day global period?

Use modifier 79 for an unrelated procedure performed during the 90-day global period. Modifier 78 applies only to an unplanned return to the OR for a complication related to the original procedure.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures the surgical approach (laminectomy vs. laminotomy), spinal level(s) exposed, electrode array type (paddle), epidural placement confirmation, and the prior successful trial date from dictation. That documentation chain directly prevents medical necessity denials and post-payment recoupment tied to inadequate trial documentation.

See how Mira captures CPT 63655 documentation