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63281 Bx/exc idrl spine lesn thrc

What 63281 is

CMS fee schedule short descriptor: Bx/exc idrl spine lesn thrc.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 63281 (CY2026)

Work RVUPractice expense RVUMalpractice RVUTotalMedicare rate
Non-facility (office)29.2419.8312.2061.27$2,046.47
Facility (hospital, ASC)29.2419.8312.2061.27$2,046.47

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.


Status: Active - payable under the Physician Fee Schedule. Global period: 90-day global period.

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Medically Unlikely Edit (MUE)

Medicare caps 63281 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 63281? These codes are bundled into it

63281 is a Column 1 code in 290 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 codeShort descriptionModifier indicator
0213TNjx paravert w/us cer/thor0 - no modifier bypassCheck pair
0216TNjx paravert w/us lumb/sac0 - no modifier bypassCheck pair
0333TVisual ep scr acuity auto0 - no modifier bypassCheck pair
0464TVisual ep test for glaucoma0 - no modifier bypassCheck pair
0565TAutol cell implt adps hrvg1 - modifier may bypassCheck pair
0596TTemp fml iu vlv-pmp 1st insj1 - modifier may bypassCheck pair
0597TTemp fml iu valve-pmp rplcmt1 - modifier may bypassCheck pair
0708TId ca immntx prep & 1st njx1 - modifier may bypassCheck pair
0709TId ca immntx each addl njx1 - modifier may bypassCheck pair
0901TPlmt bone marrow smplg port0 - no modifier bypassCheck pair
0903TEcg alg 12 lead reduced i&r1 - modifier may bypassCheck pair
0904TEcg alg 12 ld rdcd trcg only1 - modifier may bypassCheck pair
0905TEcg alg 12 ld rdcd i&r only1 - modifier may bypassCheck pair
10005Fna bx w/us gdn 1st les1 - modifier may bypassCheck pair
10007Fna bx w/fluor gdn 1st les1 - modifier may bypassCheck pair
10009Fna bx w/ct gdn 1st les1 - modifier may bypassCheck pair
10011Fna bx w/mr gdn 1st les1 - modifier may bypassCheck pair
10021Fna bx w/o img gdn 1st les1 - modifier may bypassCheck pair
11000Dbrdmt ecz/infected skin<10%1 - modifier may bypassCheck pair
11001Dbrdmt ecz/infct skn ea addl1 - modifier may bypassCheck pair
11004Dbrdmt skin xtrnl gent&per1 - modifier may bypassCheck pair
11005Dbrdmt skin abdominal wall1 - modifier may bypassCheck pair
11006Dbrdmt skin xtrnl gent per1 - modifier may bypassCheck pair
11042Dbrdmt subq tis 1st 20sqcm/<1 - modifier may bypassCheck pair
11043Dbrdmt musc&/fsca 1st 20/<1 - modifier may bypassCheck pair
11044Dbrdmt bone 1st 20 sq cm/<1 - modifier may bypassCheck pair
11045Dbrdmt subq tiss each addl1 - modifier may bypassCheck pair
11046Dbrdmt musc&/fsca ea addl1 - modifier may bypassCheck pair
11047Dbrdmt bone each addl1 - modifier may bypassCheck pair
12001Rpr s/n/ax/gen/trnk 2.5cm/<1 - modifier may bypassCheck pair

Showing 30 of 290 column 2 codes. Use the pair checker for any specific combination.

63281 is bundled into these codes

63281 appears as a Column 2 code in 5 active edits. Reported with one of these Column 1 codes on the same date of service, 63281 is the code that denies.

Column 1 codeShort descriptionModifier indicator
22206Incis spine 3 column thorac1Check pair
22207Incis spine 3 column lumbar1Check pair
63286Bx/exc idrl imed lesn thrc1Check pair
63287Bx/exc idrl imed lesn thrlmb1Check pair
63290Bx/exc xdrl/idrl lsn any lvl1Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.