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See a sample rate comparisonCPT 63042 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Surgery For Pinched Nerve, Additional Surgery To Relieve Pressure On A Nerve In The Spine. The Surgery May Include The Removal Of Part Of A Spine Bone (Vertebra) And/Or The Removal Of A Bulging Disc (The Cushion Between The Vertebra).
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Nervous System |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | None AS - PA/NP/CNS assistant at surgery LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 63042 |
| Medicaid Fee Schedule | View Medicaid rates for 63042 |
National average reimbursement for CPT 63042 by major payers:
$1,796.57
$1,789.45
$1,906.96
$2,124.04
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CPT 63042
5 of 25 sample ratesHigher to lower in this preview
Orange Asc, Ltd, Orthopedic One Surgery Center At Easton
Orange Asc Ltd Dba Orthopedic One Surgery Center At Easton
$14,865.00Published rateWisconsin Institute Of Surgical Excellence LLC
$5,854.00Published rateNashville Surgicenter, LLC
Nashville Surgicenter LLC
$3,538.00Published rateSt Johns Surgery Center LLC
$2,339.00Published rateAffiliated Ambulatory Surgery Center LLC
Affiliated Ambulatory Surgery Center, LLC
$390.00Published rate
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See a sample payer proposalCPT 63042 vs. Other Surgical Procedures on the Nervous System Codes
The CPT 63042 code is part of the Surgery services used for Surgical Procedures on the Nervous System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 63042 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 63040-CPT | High | Surgery For Pinched Nerve, Additional Surgery To Relieve Pressure On A Nerve In The Spine. The Surgery May Include The Removal Of Part Of A Spine Bone (Vertebra) And/Or The Removal Of A Bulging Disc (The Cushion Between The Vertebra). |
| 63042-CPT | High | Surgery For Pinched Nerve, Additional Surgery To Relieve Pressure On A Nerve In The Spine. The Surgery May Include The Removal Of Part Of A Spine Bone (Vertebra) And/Or The Removal Of A Bulging Disc (The Cushion Between The Vertebra). |
| 63043-CPT | Moderate | Laminotomy Addl Cervical, Laminotomy Hemilaminectomy With Decompression Of Nerve Root S Including Partial Facetectomy Foraminotomy And Or Excision Of Herniated Intervertebral Disc Reexploration Single Interspace Each Additional Cervical Interspace List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 63042. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 63042 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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