Percutaneous placement of an epidural spinal cord stimulator electrode array through a needle, reported per array, for either a trial or a permanent implant.
- Medicare
- $2,388.50
- Work RVU
- 6.97
- Global, days
- 10
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Number of arrays placed and vertebral level of each lead tip
- Trial versus permanent placement
- Psychological evaluation clearing the patient
- Failed conservative care and prior surgical history
- Trial outcome with percent pain relief and functional change before permanent placement
- Prior authorization on file
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
63650 covers percutaneous placement of an epidural neurostimulator lead through a needle. It is reported per array, so a trial with two leads is two units. It applies to both the temporary trial and the permanent implant.
Orthopedic spine practices see this in patients with persistent pain after spine surgery or chronic radiculopathy that has not responded to other care. A pain physician usually does the trial in the office or ASC. If the trial gives enough relief, the permanent leads are placed with 63650 again and the generator with 63685 on the same day.
Medicare covers spinal cord stimulation under NCD 160.7 and MAC LCDs. The usual requirements: failed conservative and surgical options, a psychological evaluation, and a successful trial (commonly at least 50 percent relief with improved function). Commercial payers usually require prior authorization for both stages. Global period is 10 days. Trial lead removal by simply pulling a temporary lead is not reported with 63661.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (6.97) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (71.51) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 6.97 |
| Practice expense RVU | 63.75 |
| Malpractice RVU | 0.79 |
| Total RVU | 71.51 |
| Medicare national rate | $2,388.50 |
| Global period | 10 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $2,388.50 |
HOPD (APC 5462) Hospital outpatient department | $6,511.03 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $5,030.95 |
Common denial reasons
The recurring reasons claims for CPT 63650 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- No psychological evaluation in the record
- Permanent placement without a documented successful trial
- Trial and permanent placement billed with the wrong place of service
- Units do not match the number of arrays placed
- Missing prior authorization
- E/M billed inside the 10-day global without modifier 24 or 25
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01How many units of 63650 for two leads?
02Is 63650 billed for a paddle lead?
03Is 63650 used for both the trial and the permanent implant?
04What does Medicare require for spinal cord stimulation?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe's notes capture the trial outcome in the patient's own words along with percent relief and functional gains, the evidence payers want before approving a permanent implant.
See how Mira captures CPT 63650 documentation