CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

What is the difference between facility and non-facility rates?

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

How much does Medicare pay for CPT 63040 in 2026?

In 2026, the national Medicare allowable for 63040 is $1287.94 in an office (non-facility) setting and $1287.94 in a facility setting. Actual payment varies by locality (GPCI).

How many RVUs is CPT 63040?

63040 carries 38.56 total RVUs in the office (non-facility) setting and 38.56 in a facility setting, including 19.80 work RVUs.

What is the global period for CPT 63040?

63040: 90-day global period — most related follow-up care within 90 days is bundled into this code's payment.

SurgeryStatus AGlobal 090

CPT Code 63040

Surgery to reopen a previous cervical spine operation site

Source: CMS 2026 Physician Fee ScheduleEffective January 1, 2026Reviewed by the D3rx Clinical Billing Team

2026 Medicare national rate

Office (non-facility)

$1287.94

Performed in a physician office

Facility

$1287.94

Hospital / ASC setting

Total RVUs (office)

38.56

38.56 facility

Conversion factor

$33.4009

2026 PFS

Medicare payment = total RVUs × GPCI (locality adjustment) × conversion factor. At the national level (GPCI = 1.0), 38.56 × 33.4009 = $1287.94 (office). Facility rates are lower because the facility separately bills its overhead.

RVU breakdown

Work RVU

19.80

Office PE RVU

12.61

Facility PE RVU

12.61

Malpractice RVU

6.15

PC/TC: Physician service — not subject to a professional/technical split.

Billing notes

63040 carries a 90-day global period: related follow-up care within 90 days is bundled into this payment and is not separately billable.
The national allowable is built from 38.56 total office RVUs × the $33.4009 conversion factor; multiply by your locality GPCIs (above) to reconcile a specific remittance.

Billing & payment rules

Multiple procedures: Standard multiple-procedure reduction applies (100% / 50% / 50%…).
Bilateral surgery: Conditional bilateral — 150% adjustment applies when performed bilaterally (modifier 50).
Assistant surgeon: Assistant surgeon may be paid.
Co-surgeons: Co-surgeons permitted.
Team surgeons: Team surgeons not permitted.
Global period: 90-day global period — most related follow-up care within 90 days is bundled into this code's payment.

2026 rate by locality

Locality	Office	Facility
National (GPCI 1.0)	$1287.94	$1287.94
Manhattan, NY	$1518.87	$1518.87
Los Angeles, CA	$1323.11	$1323.11
Houston, TX	$1367.52	$1367.52
Chicago, IL	$1560.69	$1560.69
Miami, FL	$1619.29	$1619.29
Atlanta, GA	$1337.95	$1337.95

Computed from CMS 2026 GPCIs: (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × $33.4009. Your MAC's locality may differ.

Related Surgery codes

17110 45380 45378 11042 36415 20610 62323 43235

Modifier 25 (separate E/M same day) →Modifier 59 (distinct procedural service) →

Related guides

Medical billing disclaimer

Rates shown are 2026 Physician Fee Schedule amounts and are for educational reference. Commercial payers, locality, and plan rules vary. Always verify current rates and coverage with the payer before billing. D3rx is not responsible for claim outcomes.