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What is cpt code 63052 Effective for dates of service on and after november 1, 2023, the following musculoskeletal (msk) codes will require prior authorization through carelon medical benefits management, inc.* Cpt code 63052 represents a specific surgical procedure that involves the removal of bone or tissue to relieve pressure on the spinal cord or nerve roots during a lumbar posterior interbody arthrodesis.

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Cpt code 63052 is utilized when a physician performs laminectomy, facetectomy, or foraminotomy on a single vertebral segment to alleviate compression of the spinal cord, cauda equina, or nerve roots during lumbar posterior interbody arthrodesis. This is the “medicare approved amount,” which is the total the doctor or supplier is paid for this procedure. New cpt codes 63052 and 63053 describe decompression when done with plif or tlif procedures (22630/32 and 22634/36)

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63052 describes the first level decompression and 63053 describes additional levels of decompression.

Spinal procedures for the treatment of spine pain are proven and medically necessary in certain circumstances Click here to view the interqual® criteria Isolated facet fusion, with or without instrumentation, is unproven and not medically necessary due to insufficient evidence of efficacy. Here’s an easy way to think about it

Use the new codes (63052 and 63053) when Your asc performs decompression of neural elements at the same level (s)/interspace as lumbar interbody fusion. With cpt assistant, you can navigate the complexities of medical coding with unparalleled confidence This resource offers authoritative answers and expert explanations that help reduce coding errors, leading to fewer claim denials and streamlined appeals processes.

This includes facility and doctor fees

You may need more than one doctor and additional costs may apply