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Code 63030 and 63035

  1. #1
    Provo Utah Chapter
    Default Code 63030 and 63035
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    Can anyone help me with finding out what the facility reimbursement is for the above codes? Also I am wondering if anyone knows if they can be done on an outpatient basis. I bill for a pain management doc who is wondering what the facility is getting paid for these procedures when he does them. Thanks!

  2. #2
    Important thing to note is typically when pain management physician's is doing a minimually invasive procedure that is consider a newer, more invasive than the standard pain management procedures that procedure for example, the MILD procedure would be using an endoscope but it is an unlisted procedure if you would ask the AMA how to code it.

    The below link talks about 64999 versus 63030 with a certain type of procedure.

    In the above link, you can choose the Medicare tab and review ASC approved procedures and check the rate calculator which can be a more reliable number than just a national average if you are not going to look this on for example then the Medicare MAC site for your location.

    Above is a consultant's website that has fee schedule with commercial carrier averages for physician side.

    The above link is Addendum B which provides outpatient hosital reimbursment for Medicare' Outpatient Perspective Payment System.

    You ask if 63030 can be performed on an outpatient basis, you could ask the physician if he feels the patient would require at least 24 hours or more of nursing care/monitoring. But 63030 has a status indicator of T versus having a status indicator of C which would be Inpatient procedure that is not on the outpatient fee schedule and would fall under ICD-9 procedure code 80.51 or 03.09 depending of it he is doing a discectomy or foraminotomy.

  3. #3
    Provo Utah Chapter
    Thank you soooooo much!

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