How much does Medicare pay for CPT 63685?

Medicare allowed an average of $10,072 per service and paid $8024.73 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $26,793, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 63685?

Insertion or replacement of spinal neurostimulator generator or receiver. It was billed 27,098 times to 26,743 Medicare beneficiaries by 1,210 providers in 2024.

Does 63685 pay differently in an office than a hospital?

Yes. The allowed amount averaged $197.34 in an office setting and $10,149 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 63685 most?

Ambulatory Surgical Center, with 11,234 services from 420 clinicians. Next are Neurosurgery, Pain Management, Anesthesiology.

CPT 63685

Insertion or replacement of spinal neurostimulator generator or receiver

$10,072Medicare-allowed amount per service, averaged across 27,098 services

Providers submitted

$26,793

Asking price, not received

Medicare allowed

$10,072

The fee schedule figure

Medicare paid

$8024.73

Balance is patient coinsurance

Providers submitted an average of $26,793 for this code and Medicare allowed $10,072 — 2.7× 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 $8024.73 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $197.34
Hospital / facility: $10,149

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 210 services were billed in an office setting and 26,888 in a facility.

Services: 27,098
Beneficiaries: 26,743
Providers billing it: 1,210
Total allowed: $272,918,049

What Medicare pays for CPT 63685

Across 27,098 services billed by 1,210 providers to 26,743 beneficiaries, Medicare allowed an average of $10,072 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 63685

Specialty	Services	Beneficiaries	Avg allowed	Providers
Ambulatory Surgical Center	11,234	11,090	$24,047	420
Neurosurgery	3,753	3,692	$205.57	172
Pain Management	2,928	2,886	$192.43	163
Anesthesiology	2,481	2,465	$192.92	128
Interventional Pain Management	1,820	1,790	$191.20	96
Physician Assistant	1,633	1,618	$33.90	78
Orthopedic Surgery	1,357	1,345	$198.71	65
Physical Medicine and Rehabilitation	1,131	1,110	$187.86	50
Nurse Practitioner	455	451	$35.61	25
Neurology	177	170	$166.33	5
Interventional Radiology	23	22	$188.43	1
Cardiology	18	17	$213.27	1
Diagnostic Radiology	17	17	$161.14	1
Sports Medicine	15	15	$195.24	1
Osteopathic Manipulative Medicine	15	15	$270.55	1

63685 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
Texas	4,303	$10,431	$8877.39	164
Florida	2,292	$9681.81	$8336.08	104
California	2,222	$14,391	$9979.94	94
Arizona	1,172	$13,187	$10,828	59
North Carolina	1,148	$6985.88	$6065.44	44
Tennessee	1,065	$10,247	$9150.34	41
South Carolina	906	$6447.31	$5586.30	37
Oklahoma	901	$9395.73	$8151.14	30
Pennsylvania	882	$7334.30	$6078.42	43
Missouri	721	$8884.47	$7627.60	34
Indiana	720	$10,169	$8416.12	36
Maryland	714	$13,112	$10,615	32
Mississippi	655	$9510.74	$8884.73	19
Utah	644	$8611.33	$7209.42	20
Ohio	642	$7458.05	$6386.78	34
Illinois	638	$11,014	$8880.97	33
Minnesota	621	$11,311	$9001.44	22
Washington	547	$11,864	$8862.25	30
Georgia	514	$9911.99	$8341.98	31
Kansas	513	$7437.97	$6390.59	27
Oregon	448	$15,142	$11,353	23
Nevada	444	$13,892	$10,766	18
Virginia	432	$5088.68	$4329.49	21
Michigan	427	$7279.57	$6536.31	23
New Jersey	402	$12,887	$9655.14	21
Arkansas	328	$7254.33	$6484.40	14
New York	306	$8831.98	$6915.06	18
Wisconsin	276	$8978.00	$7412.80	17
Louisiana	269	$7477.41	$6828.41	18
Kentucky	240	$8908.03	$7634.92	11
Nebraska	231	$13,186	$11,004	10
Alabama	223	$6244.54	$6101.69	12
Colorado	219	$10,601	$8728.06	10
Idaho	184	$7737.10	$6948.76	10
Delaware	147	$10,930	$8600.27	7
Montana	124	$3287.71	$2845.31	6
Massachusetts	102	$5380.70	$3800.67	7
New Hampshire	79	$9358.85	$7923.25	4
South Dakota	78	$4911.13	$4188.52	3
Iowa	70	$7414.86	$6321.15	5
North Dakota	66	$3976.36	$3406.74	5
Wyoming	40	$6632.86	$5559.96	2
District of Columbia	38	$240.71	$172.22	3
West Virginia	32	$7861.16	$6949.60	2
Alaska	27	$25,945	$19,982	2
Maine	12	$163.89	$133.96	1
New Mexico	12	$23,110	$19,815	1
Hawaii	11	$26,690	$19,815	1
AE	11	$26.78	$18.25	1

Related codes

63650Insertion of spinal neurostimulator electrode array through skin$2401.98
63655Removal of spine bone for insertion of neurostimulator electrode plate$4462.44

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.