2025 CPT code 63030
(Active) Effective Date: N/A Revision Date: N/A Surgery - Spine surgery Musculoskeletal System Feed
Laminotomy (hemilaminectomy) with nerve root decompression, including partial facetectomy, foraminotomy, and/or excision of a herniated intervertebral disc; one lumbar interspace.
Modifier 50 (Bilateral Procedure) is used for bilateral procedures.Modifiers 59 (Distinct Procedural Service) or XS (Separate Structure) may be appropriate depending on the circumstances and payer requirements for multiple level surgeries.
Medical necessity is established through clinical findings such as radiculopathy, myelopathy, or cauda equina syndrome due to nerve root or spinal cord compression.Preoperative imaging should demonstrate the anatomical basis for compression.
The neurosurgeon or orthopedic surgeon is responsible for performing the laminotomy, decompression, partial facetectomy, foraminotomy, and/or disc excision.Anesthesiologist and surgical team are involved in the overall procedure.
In simple words: This surgery involves removing a portion of the bone (lamina) in your lower back to relieve pressure on a nerve. It may also include removing a herniated disc or part of a facet joint. This is done through an open or minimally invasive approach.
This code encompasses laminotomy (hemilaminectomy), a partial laminectomy involving the removal of the upper and lower portions of adjacent laminae on either side of a vertebral interspace, rather than the entire lamina of a single vertebra.It includes decompression of the nerve root(s), partial facetectomy, foraminotomy, and/or excision of a herniated intervertebral disc. The procedure can be performed using open or endoscopic approaches.For bilateral procedures, report 63030 with modifier 50.Each additional lumbar interspace beyond the first requires reporting of +63035.
Example 1: A 45-year-old patient presents with severe lower back pain radiating down the leg (sciatica) due to a herniated L4-L5 disc. A laminotomy at L4-L5 is performed to decompress the nerve root., A 60-year-old patient experiences chronic lower back pain and leg weakness due to spinal stenosis. A bilateral laminotomy at L3-L4 and L4-L5 is performed to decompress the spinal canal and nerve roots., A 30-year-old patient suffers from severe lower back pain and numbness in the leg secondary to a bone spur impinging on a nerve root. A laminotomy is performed, and the bone spur is removed during the procedure.
Detailed operative report including approach (open or endoscopic), levels involved, structures decompressed, findings, and any complications.Preoperative imaging (MRI, CT) demonstrating the need for the procedure.Postoperative neurological examination.
** Always consult your payer’s specific coding guidelines and local coverage determinations to ensure accurate reimbursement.Understanding the different approaches (open, endoscopic) is essential for precise coding.
- Revenue Code: P1F (Major Procedure - Explor/Decompr/ExcisDisc)
- RVU: This information varies based on geographic location and payer. Consult a fee schedule or pricing tool for specific RVU data.
- Global Days: The global period will vary depending on payer policies and the specifics of the procedure, including if additional procedures were performed.
- Payment Status: Active
- Modifier TC rule: Not applicable to this code.The code represents the entire surgical procedure.
- Fee Schedule: Historical fee schedule data is not available in this dataset; this information is dependent on payer, location and date.
- Specialties:Neurosurgery, Orthopedic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital