ANNULAR CLOSURE
Facility: Hospital Outpatient or ASC (Commercial Payors) Hospital ASC
CPT/HCPCS Description Outpatient Hospital Payment ASC Payment
C9757 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar
Payor Priced Payor Priced
Revenue Codes
CPT/HCPCS Revenue Code Description
C1713 0278 Anchor/screw bn/bn, tis/bn
C9757 0360 OR Services
1 CPT is a registered trademark of the American Medical Association2 2020 CMS OPPS/ASC Final Rule, Addendum B (available on CMS website), 84 Fed. Reg. 218 (Nov. 12, 2019).3 2020 CMS OPPS/ASC Final Rule, Addendum AA (available on CMS website), 84 Fed. Reg. 218 (Nov. 12, 2019).
Commonly Billed Codes 2020
Diagnosis Coding
ICD-10-CM Description
M51.06 Intervertebral disc disorders with myelopathy, lumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.26 Other intervertebral disc displacement, lumbar region
M51.27 Other intervertebral disc displacement, lumbosacral region
M51.36 Other intervertebral disc degeneration, lumbar region
M51.37 Other intervertebral disc degeneration, lumbosacral region
M54.30 Sciatica, unspecified side
M54.32 Sciatica, left side
Facility: Medicare Hospital Outpatient or ASC (National Average Payment)
Hospital Outpatient ASC
CPT1/HCPCS Description APC APC Payment2 SI Payment3 PI
C9757 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar
5115 $11,900.71 J1 $7,465.38 J8
C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)
Unassigned Unassigned N Not Utilized in ASC
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Facility: Hospital Inpatient
Possible MS-DRG Description 2020 MS-DRG Payment4
028 Spinal Procedures w MCC $34,990.09
029 Spinal Procedures w CC or Spinal Neurostimulators $20,072.48
030 Spinal Procedures w/o CC/MCC $14,220.98
Physician Services Hospital/ASC Commercial
CPT/HCPCS Description Medicare PFS - Facility5 Physician Fee
63030 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar
$1,014.48 Payor Priced
63042 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar
$1,354.80 Payor Priced
22899 Unlisted procedure, spine Local MAC Priced Payor Priced
2020 Medicare Facility RVU5
CPT Code Work RVU Facility PE RVU MP RVU Total Facility RVUs
63030 13.18 11.01 3.92 28.11
63042 18.76 13.57 5.21 37.54
22899 N/A N/A N/A N/A
4 2020 CMS IPPS Final Rule, Tables 1B, 1D and 5 (available on CMS website), 84 Fed. Reg. 159 (Aug. 16, 2019).5 2020 CMS PFS Final Rule, Addendum B (available on CMS website), 84 Fed. Reg. 221 (Nov. 15, 2019).
Facility: Hospital Inpatient
ICD-10-PCS Description
Lumbar/Lumbosacral Discectomy
0SB20ZZ Excision of Lumbar Vertebral Disc, Open Approach
0SB24ZZ Excision of Lumbar Vertebral Disc, Percutaneous Endoscopic Approach
0SB40ZZ Excision of Lumbosacral Disc, Open Approach
0SB44ZZ Excision of Lumbosacral Disc, Percutaneous Endoscopic Approach
Implantation of the Barricaid
0SU20JZ Supplement Lumbar Vertebral Disc with Synthetic Substitute, Open Approach
0SU40JZ Supplement Lumbosacral Disc with Synthetic Substitute, Open Approach
Barricaid Reimbursement Support
Disclaimer Healthcare providers are solely responsible for reporting the codes that accurately describe the services provided to a particular patient as well as the patient’s medical condition or diagnosis. Providers should follow payor-specific billing and coding requirements and contact the payor if they have questions. Note that the existence of a code for a procedure does not guarantee coverage or payment. This guide includes Medicare national average payment rates. Payment rates to individual providers will vary based on geographic location and other provider-specific factors, including participation in various quality programs.
The information included herein is shared for educational purposes only and does not constitute legal advice. The information is based upon publicly available information. Providers are reminded that reimbursement is dynamic. Codes, coverage, and payment rates change, at minimum, on an annual basis, and may be changed periodically throughout the year. The information is current as of February 20, 2020.
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