63030
Surgical procedure to decompress herniated vertebra
Our Work > Good Faith Estimates > Decompress Herniated Vertebra
Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Surgical procedure to decompress herniated vertebra appears on both lists, and there is a standard service package available for it.
A laminotomy removes only a portion of the lamina, the back part of a spinal bone. It carves a hole just big enough to relieve the pressure in a specific spot. This procedure may be performed on the neck or on the lumbar spine.
Your service utilization may vary from this service package for a number of reasons, including your unique clinical profile and where you receive your services.
This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in the below care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 85%
- Free standing ASC: 15%
Item Definitions
Index
Index
this is the fee for the service being defined; note that other codes may be used to define a similar service
Facility Fee
Facility Fee
these fees are most commonly associated with the index event; these may also be
paid to the facility in addition to the index fee
Professional Fee
Professional Fee
these fees are paid to clinicians for the work associated with this service
Optional Fee
Optional Fee
these services are often also billed with the index event, however may vary based on the patient’s individual circumstances
Ancillary Service
Ancillary Service
these are supply codes that identify other services that may be billed with the index event
Proposed Technical Definition
| association | base_code | code_type | estimated_charge | item_type | name |
|---|---|---|---|---|---|
| 1 | 63030 | CPT | 22089 | index | Laminotomy to decompress herniated disk |
| 1 | 63030 | CPT | 3849.5 | professional_fee | Laminotomy to decompress herniated disk |
| 0.987226468 | 360 | Revenue Code | facility_fee | OR services | |
| 0.88831885 | 636 | Revenue Code | facility_fee | Drugs requiring detailed coding | |
| 0.787195058 | J2405 | HCPCS | 50 | facility_fee | Ondansetron hydrochloride injection |
| 0.782588211 | J3010 | HCPCS | 52 | facility_fee | Fentanyl citrate injection |
| 0.692545283 | J0690 | HCPCS | 93.735 | facility_fee | Cefazolin sodium injection |
| 0.681 | 630 | CPT | 46.56 | professional_fee | Anesthesia for procedures in lumbar region |
| 0.676944823 | J1100 | HCPCS | 55.25 | facility_fee | Dexamethasone sodium phosphate injection |
| 0.671290964 | J2250 | HCPCS | 50 | facility_fee | Midazolam hydrochloride injection |
| 0.652566921 | 320 | Revenue Code | facility_fee | Radiology Diagnostic | |
| 0.651275608 | J2704 | HCPCS | 70.13 | facility_fee | Propofol injection |
| 0.556154678 | 72020 | CPT | $130 | facility_fee | Radiologic examination of spine |
| 0.470282344 | J1170 | HCPCS | 58.635 | facility_fee | Hydromorphone injection |
| 0.452256308 | 250 | Revenue Code | ancillary_service | Pharmacy | |
| 0.405594528 | 710 | Revenue Code | ancillary_service | Recovery Room | |
| 0.380099815 | 370 | Revenue Code | ancillary_service | Anesthesia | |
| 0.378284996 | J7120 | HCPCS | 105.6 | optional_fee | Ringers lactate infusion |
| 0.364289952 | 272 | Revenue Code | ancillary_service | Sterile supplies | |
| 0.313841483 | 300 | Revenue Code | optional_fee | Lab services | |
| 0.30293512 | J2710 | HCPCS | 158 | facility_fee | Neostigmine methylsulfate injection |
Captured Spending (N=20,000)
| Decile | Base Fee (Facility + Professional) | Base Fee + Optional Fees |
| 1 | 2% | |
| 2 | 0% | |
| 3 | 1% | |
| 4 | 1% | |
| 5 | 2% | |
| 6 | 3% | |
| 7 | 5% | |
| 8 | 7% | |
| 9 | 14% | |
| 10 | 65% |
Our Work > Good Faith Estimates > Decompress Herniated Vertebra