Question 1

What is a global period in neurosurgery billing?

Accepted Answer

A global period is the span around a procedure during which the surgeon's payment covers routine care. Most spinal fusions and craniotomies carry 90 days, and some smaller procedures carry 0 or 10 days. Postoperative visits inside the window are not billed separately unless they are unrelated and reported with a modifier such as 24. We log included visits with 99024 so none are billed by mistake.

Question 2

What CPT codes are used to bill a spinal cord stimulator trial and implant?

Accepted Answer

A percutaneous lead is billed with 63650 and a paddle lead placed through a laminectomy with 63655. The permanent generator is 63685, and 63688 covers generator revision or removal. Plans usually want a successful trial and a psychological evaluation first, for example UnitedHealthcare's Medicare Advantage policy asks for at least a 50 percent reduction in target pain or analgesic use. We attach the trial results and evaluation to the authorization request.

Question 3

When can you bill CPT 61783 for spinal navigation?

Accepted Answer

Report 61783 as an add-on code with the primary spinal procedure, once per surgical session, when stereotactic navigation is used. Medicare's NCCI policy does not allow it with simple spinal decompression, codes 63001 through 63053, and it is not reported with radiosurgery codes 63620 and 63621. The operative note should say navigation was used and why. Payer policies on navigation differ, so we check each plan before the claim goes out.

Question 4

Can you bill 69990 operating microscope with spine surgery?

Accepted Answer

Usually not. Medicare pays 69990 only with listed procedures, including cranial codes 61304 to 61546, 61550 to 61711 and 62010 to 62100, codes 63081 to 63308, and certain peripheral nerve repair codes. Common spine cases such as ACDF 22551 or lumbar laminectomy 63047 are not on that list, so the microscope line is bundled or denied. Commercial payers can differ, so our coders check the plan policy first.

Question 5

What are the CPT codes for kyphoplasty and vertebroplasty?

Accepted Answer

Vertebroplasty is 22510 for one cervicothoracic body, 22511 for one lumbosacral body and 22512 for each additional body. Kyphoplasty, or vertebral augmentation with a mechanical device, is 22513 for one thoracic body, 22514 for one lumbar body and 22515 for each additional thoracic or lumbar body. Imaging guidance is included in these codes, so it is not billed separately. Payers set their own fracture age and conservative care rules, so we check them before the date is set.

Question 6

How does Medicare pay assistant surgeons and co-surgeons on spine cases?

Accepted Answer

Medicare pays an assistant surgeon billing 80 or 82 at 16 percent of the fee schedule amount, and a PA or nurse practitioner billing AS at 85 percent of that, which is 13.6 percent. Each co-surgeon billing 62 is paid 62.5 percent of the fee schedule amount. Each code carries assistant and co-surgery indicators that decide whether payment is allowed, and co-surgery needs notes showing why two surgeons were required. Commercial plans set their own rates.

Question 7

Does traditional Medicare require prior authorization for spine surgery and spinal cord stimulators?

Accepted Answer

Only for selected services in six states so far. Under the CMS WISeR model, which began January 1, 2026, prior authorization applies in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. CMS lists cervical fusion CPT 22554, spinal cord stimulators and percutaneous vertebral augmentation, and says participants typically decide within 3 calendar days. The list can change, so we check the current CMS guide before scheduling.

Question 8

Can you bill a laminectomy and a fusion at the same level?

Accepted Answer

Usually not. Medicare's NCCI policy does not allow separate payment for 63042 or 63047 with lumbar arthrodesis codes 22630 or 22633 at the same interspace. Decompression at a different interspace may be reported separately with modifier 59 or XS when the operative note supports it. The note should describe the work at each level, and commercial payers can have their own edits, so we review each case before billing.

Question 9

How do you bill deep brain stimulation surgery and programming?

Accepted Answer

Electrode placement is 61863 for the first array and 61864 for each additional array, or 61867 and 61868 when intraoperative microelectrode recording is used. The generator is a separate line, 61885 for one electrode array or 61886 for two or more. Programming is reported with 95983 for the first 15 minutes of face to face time and 95984 for each added 15 minutes. Staged cases need their own dates of service, which we confirm against the implant log.

Question 10

How do Medicare fee schedule changes affect neurosurgery payments in 2026 and 2027?

Accepted Answer

It depends on the code, but procedures took a cut. For 2026 CMS reduced work values by 2.5 percent for most non time based services, which are mainly procedural codes, and set the non qualifying APM conversion factor at $33.4009. The CY 2027 proposed rule, which is not final, would lower that factor to $32.8409, and the comment period closed September 14, 2026. We model the effect on your most billed CPT codes.

Question 11

How do you bill a neurosurgery consult that leads to emergency surgery?

Accepted Answer

Medicare has not recognized consultation codes since January 1, 2010, so a neurosurgeon reports an emergency department visit or initial hospital care, 99221 to 99223, instead. If that visit results in the decision for surgery on the same day or the day before a procedure with a 90 day global period, add modifier 57. Commercial payers set their own rules on consultation codes, so we check each contract.

Question 12

How do you bill removal or revision of spinal hardware?

Accepted Answer

Removal of posterior nonsegmental instrumentation is 22850, posterior segmental instrumentation is 22852 and anterior instrumentation is 22855, while reinsertion of a spinal fixation device is 22849. When new instrumentation is placed at levels that already had hardware, CPT guidance generally has you report the insertion or reinsertion code rather than a separate removal code. The operative note must say which levels were removed and which were reinstrumented, and we code from it.

Question 13

Can you bill Medicare while a personal injury claim is pending?

Accepted Answer

Sometimes. Claims go to the liability insurer first, but Medicare may make a conditional payment when it does not expect prompt payment, which for liability coverage means payment within 120 days of the claim or lien being filed. Medicare then recovers that payment from the settlement. The 12 month Medicare timely filing limit still applies, so we track both the settlement timeline and the filing deadline on every injury case.

Question 14

How long do we have to appeal a denied spine surgery claim?

Accepted Answer

For Original Medicare, you have 120 days from receipt of the remittance advice to request a redetermination, then 180 days from receipt of that decision to request a reconsideration. After the reconsideration, you have 60 days to request an ALJ hearing, which needs at least $200 in controversy in 2026. Receipt is presumed five days after the notice date. Commercial and Medicare Advantage plans set their own windows, so we calendar each one.

Question 15

How much do neurosurgery billing services cost?

Accepted Answer

Most billing companies charge a percentage of the revenue they collect, and published industry ranges commonly fall between 4 and 8 percent, with some offering flat monthly fees. The rate depends on claim volume, payer mix, how much work is included, such as coding, authorization and credentialing, and the state of your accounts receivable. We quote after reviewing your volume and payer mix.

Question 16

How do you bill a multilevel spinal fusion?

Accepted Answer

The first level is billed with a primary code, and each additional level is billed with an add-on code, so a three level posterolateral lumbar fusion uses 22612 once and 22614 twice. Instrumentation is added by segment count, and bone graft is added by graft type and harvest site. The operative note has to list every level, the technique and the devices, because we build the claim from it.

Question 17

What is modifier 62 and when do co-surgeons use it?

Accepted Answer

Modifier 62 is used when two surgeons each perform distinct parts of one procedure, as with a spine surgeon and an access surgeon on an anterior lumbar fusion. Each surgeon bills the same code with 62, and each is paid a share of the fee. Payers allow co-surgery only for certain codes, so we check the rule first and make sure both claims match.

Question 18

Who bills intraoperative neuromonitoring?

Accepted Answer

The provider who performs the monitoring bills it, not the surgeon. In room, one on one monitoring is billed with 95940 in 15 minute units, and Medicare uses G0453 for remote monitoring. The claim needs the monitoring log with start and stop times. We confirm who monitored and for how long before any claim is built.

Question 19

Can you bill for a return to the operating room after spine surgery?

Accepted Answer

Yes, when it is related to the first surgery, with modifier 78. Payers generally pay only the intraoperative portion and do not start a new global period. A planned second stage uses modifier 58 instead, and an unrelated procedure uses 79. Under Medicare's global surgery rules, a complication that does not need the operating room is included in the surgeon's payment. Commercial payers set their own rules, so we check each policy.

Question 20

Do you handle prior authorization for spine surgery?

Accepted Answer

Yes. Many commercial and Medicare Advantage plans require approval for elective spine surgery and ask for visit notes, recent imaging and a record of conservative treatment such as therapy or injections. For plans covered by the federal prior authorization rule (CMS-0057-F), payers must decide within 72 hours for urgent requests and 7 calendar days for standard ones. We build the packet from the chart and track the request to a decision.

Question 21

Can you bill workers compensation and personal injury cases?

Accepted Answer

Yes. Workers compensation follows state fee schedules, carrier or adjuster approval, specific forms and set filing windows. Trauma and auto cases may be paid through medical payments coverage or a letter of protection that pays on settlement. We set up each case type on its own track because the rules, the forms and the timelines differ.

Question 22

What do you need from us to get started?

Accepted Answer

EHR or practice management access, your payer list and fee schedules, your recent denial reports, and a list of surgeons and sites. We usually begin with an audit of surgical claims and open global periods, because that is where the fastest gains are.

Question 23

What should a neurosurgery practice look for in a billing company?

Accepted Answer

Look for coders who understand multilevel spine claims, co-surgeon and assistant rules, neuromonitoring and implant billing, and who track each 90 day global period. Ask how prior authorization is handled for spine surgery, who owns denials, and what reports you receive. DrCareMSO builds spine claims level by level and aligns co-surgeon claims before either is submitted.

Question 24

How do neurosurgery billing services handle spinal fusion claims?

Accepted Answer

A fusion claim is assembled from the operative note: the approach, the number of levels, the graft, the instrumentation and any extra work. We confirm each piece is documented, bill levels in the right order, attach implant detail and check whether co-surgeons or an assistant were involved. Authorization is requested ahead of the case and the global period opens on the date of surgery.

Question 25

Do you bill for cranial surgery, brain tumor and neurostimulator cases?

Accepted Answer

Yes. We bill cranial and skull base surgery, brain tumor resection, shunts, aneurysm and vascular procedures, peripheral nerve surgery, spinal cord and pain pump or stimulator implants, and the related neuromonitoring. Each case type has its own approval rules and documentation needs, which we set up for your surgeons.

Question 26

How do you handle billing for intraoperative neuromonitoring?

Accepted Answer

Neuromonitoring is billed by the provider who actually performs and interprets it, with the monitoring time and supervision documented. We confirm who is billing, whether the payer covers monitoring for the procedure, and that the surgeon's claim and the monitoring claim do not conflict, so neither is denied for duplication.

Question 27

How do you reduce denials for neurosurgery claims?

Accepted Answer

We verify coverage and approval before surgery, match the operative note to every level and component, align co-surgeon and assistant claims, apply global period and bundling rules before submission, and fix rejections the same week. Monthly reports group the remaining denials by cause so the source can be fixed for good.

Question 28

How do I choose a neurosurgery billing company?

Accepted Answer

Look for coders trained in neurosurgery claims, a plan for authorizations before the case or study, denial follow-up that continues until the claim is paid or appealed, and a monthly report you can read without a billing background. Ask who owns the payer deposits (they should go to your account) and ask to see a sample report before you sign.

Question 29

Is outsourcing billing a good fit for a small neurosurgery practice?

Accepted Answer

Often yes. A small practice carries the same payer rules as a large one, but with fewer staff to track spine, cranial and neurostimulator cases. Outsourcing replaces a part time billing hire with a team that works the claims every day. The right choice depends on your volume and how much time your staff spend on denials today, and we can look at your numbers with you on the first call.

Question 30

What reports will I receive from a neurosurgery billing company?

Accepted Answer

We send a monthly report that shows what was billed and paid, what is still open and why denials happened, grouped by cause so the source can be fixed. You can also ask for the payer mix and the oldest unpaid claims. Report details are agreed when you start, so you only get what you will use.

Neurosurgery medical billing, from spinal fusion to craniotomy

What does a neurosurgery billing company do?

Where neurosurgery claims lose money

Multilevel spine cases billed level by level

Co-surgeons whose claims must agree

Neuromonitoring billed under the wrong provider

Spine approvals, trauma and injury cases

What we bill in every neurosurgery claim

Spinal fusion and instrumentation

Spinal decompression and disc surgery

Cranial surgery

Neurostimulation and nerve surgery

Radiosurgery and neuromonitoring

How one fusion becomes a claim

How we run neurosurgery RCM

Verify coverage and surgical criteria

Capture the case at the source

Code the case level by level

Align co-surgeons and route monitoring

Submit, work denials and fix the cause

Why neurosurgery practices choose DrCareMSO

Certified coders for neurosurgery claims

Approvals before the case is scheduled

Every denial worked to payment

A monthly report in plain language

One neurosurgery group, three leaks, fixed

Before

After

Neurosurgery billing questions

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