How much does Medicare pay for CPT 63052?

Medicare allowed an average of $172.81 per service and paid $137.97 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1198.83, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 63052 pay differently in an office than a hospital?

Yes. The allowed amount averaged $141.72 in an office setting and $172.89 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 63052 most?

Neurosurgery, with 10,830 services from 513 clinicians. Next are Orthopedic Surgery, Physician Assistant, Nurse Practitioner.

CPT 63052

Partial removal of bone of single segment of spine in lower back with release of spinal cord and/or nerves during fusion of spine in lower back

$172.81Medicare-allowed amount per service, averaged across 29,501 services

Providers submitted

$1198.83

Asking price, not received

Medicare allowed

$172.81

The fee schedule figure

Medicare paid

$137.97

Balance is patient coinsurance

Providers submitted an average of $1198.83 for this code and Medicare allowed $172.81 — 6.9× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $137.97 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $141.72
Hospital / facility: $172.89

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 74 services were billed in an office setting and 29,427 in a facility.

Services: 29,501
Beneficiaries: 29,348
Providers billing it: 1,416
Total allowed: $5,098,068

What Medicare pays for CPT 63052

Across 29,501 services billed by 1,416 providers to 29,348 beneficiaries, Medicare allowed an average of $172.81 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 63052

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurosurgery	10,830	10,760	$239.12	513
Orthopedic Surgery	9,010	8,967	$239.62	424
Physician Assistant	7,637	7,605	$33.68	375
Nurse Practitioner	1,867	1,859	$33.05	95
Neurology	47	47	$211.37	3
Osteopathic Manipulative Medicine	31	31	$229.55	1
Undefined Physician type	21	21	$245.54	1
Cardiology	19	19	$238.31	1
Certified Clinical Nurse Specialist	15	15	$35.05	1
Physical Medicine and Rehabilitation	13	13	$38.68	1
Hospitalist	11	11	$247.81	1

63052 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	2,546	$180.40	$131.88	105
Texas	1,915	$170.91	$137.91	85
Arizona	1,319	$162.75	$135.03	47
Indiana	1,177	$150.40	$136.97	59
Illinois	1,141	$193.82	$139.10	52
California	1,116	$182.17	$144.04	59
Colorado	1,091	$162.34	$131.30	55
Virginia	1,076	$178.47	$148.32	53
Pennsylvania	1,060	$202.01	$163.13	45
Ohio	1,037	$185.06	$151.65	54
North Carolina	989	$160.58	$136.79	58
Massachusetts	922	$209.07	$163.61	40
South Carolina	909	$160.01	$136.82	50
Georgia	908	$173.60	$141.40	43
Maryland	859	$191.87	$145.59	33
New York	807	$226.37	$158.79	50
Michigan	797	$193.55	$145.35	46
Tennessee	753	$170.15	$156.23	38
Oklahoma	663	$151.75	$130.18	28
Missouri	662	$157.85	$129.91	36
Nebraska	636	$132.59	$123.84	33
Washington	598	$167.72	$135.38	29
Louisiana	545	$150.37	$125.86	26
Mississippi	456	$137.75	$124.22	13
Kansas	454	$158.11	$141.89	21
Alabama	443	$121.90	$110.48	24
Nevada	410	$151.69	$124.18	16
Kentucky	400	$181.07	$153.50	21
Minnesota	398	$155.21	$139.39	23
Iowa	378	$167.99	$151.93	16
Arkansas	373	$182.09	$166.88	19
Oregon	365	$159.49	$138.83	18
North Dakota	305	$143.00	$126.18	7
Utah	280	$174.07	$145.32	16
South Dakota	246	$130.03	$116.27	13
New Jersey	238	$164.36	$122.86	12
Montana	236	$192.25	$156.64	9
Idaho	209	$143.49	$131.51	13
Connecticut	209	$206.83	$151.41	13
Wisconsin	144	$188.53	$170.52	10
Wyoming	77	$208.63	$169.39	5
New Mexico	68	$147.01	$116.72	4
Alaska	61	$211.00	$138.34	4
New Hampshire	58	$166.32	$131.81	5
District of Columbia	51	$232.53	$162.87	3
West Virginia	41	$133.49	$99.31	2
Delaware	33	$135.14	$111.57	2
Maine	22	$237.31	$200.57	2
Rhode Island	20	$228.49	$184.46	1

Related codes

63048Partial removal of spine bone$147.82
63047Partial removal of spine bone$700.79
63053Partial removal of bone of additional segment of spine in lower back$156.39
63030Partial removal of spine bone$1056.97
63045Partial removal of spine bone$692.40
63056Release of lower spinal cord and/or nerves$948.73
63042Partial removal of spine bone$1003.68
63057Release of middle or lower spinal cord and/or nerves$201.97

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.