Insertion or replacement of a spinal neurostimulator pulse generator or receiver, including creating the pocket and connecting it to the implanted electrode leads.
- Medicare
- $318.64
- Work RVU
- 5.06
- Global, days
- 10
- 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 ↓
- New implant or replacement, and reason for replacement
- Pocket location and lead connections
- Successful trial results for a first permanent implant
- Ongoing benefit from the system for replacements
- Device model and serial number
- Prior authorization on file
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 ↓
63685 covers implanting or replacing the pulse generator or receiver for a spinal cord stimulator. That includes creating the subcutaneous pocket and connecting the generator to the leads. It is reported once per generator.
For a new permanent system, the claim usually has 63650 per lead (or 63655 for paddle leads) plus 63685 on the same date. For a battery change at end of life, 63685 alone covers removal of the old generator and placement of the new one. Do not add 63688 for removing the old unit during a replacement, since 63685 already includes it.
Global period is 10 days. Medicare coverage follows NCD 160.7 and local LCDs, which need a successful trial on record before the permanent generator. For replacements, the note should show ongoing benefit from the system and the reason for replacement, such as battery depletion or device failure. The device itself is billed by the facility, not the physician, in a hospital or ASC setting. Payers often require prior authorization for both new and replacement generators.
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 (5.06) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.54) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 5.06 |
| Practice expense RVU | 3.43 |
| Malpractice RVU | 1.05 |
| Total RVU | 9.54 |
| Medicare national rate | $318.64 |
| Global period | 10 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 | $318.64 |
HOPD (APC 5465) Hospital outpatient department | $31,526.06 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $27,485.81 |
Common denial reasons
The recurring reasons claims for CPT 63685 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- 63688 billed with 63685 for a generator replacement
- No documented successful trial before permanent implant
- Missing prior authorization
- Replacement without documented battery depletion or failure
- Billed twice for one generator
- Post-op visits billed inside the 10-day global
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Is 63688 billed with 63685 for a battery change?
02What codes are billed for a permanent spinal cord stimulator?
03What is the global period for CPT 63685?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's follow-up notes track pain relief, function, and device use over time, so a replacement generator has a clear record of ongoing benefit.
See how Mira captures CPT 63685 documentation