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See a sample rate comparisonCPT 63042 Fee Schedule
Medicare rates as of October 2026
CPT 63042 is classified under Surgery, in the Surgical Procedures on the Nervous System subgroup.
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 | AS - PA/NP/CNS assistant at surgery LT - Left side of body |
| Complexity Level | High |
| Medicare Fee Schedule | $1,219.80 national non-facility rate (2026) · View Medicare rates for 63042 |
| Medicaid Fee Schedule | $987.59 median of the 8 states in the free preview · View Medicaid rates for 63042 |
National average reimbursement for CPT 63042 by major payers:
$1,796.57
BCBS / Anthem
$1,789.45
UnitedHealthcare
$1,906.96
Aetna
$2,124.04
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 63042.
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 table lists codes related to 63042. Select one to see its fee schedule.
| 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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