What do doctors typically charge for Partial Removal of Spine Bone with Re-exploration?

The nationwide median physician charge for Partial Removal of Spine Bone with Re-exploration (CPT 63042) is $3935.84. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 63042?

The standard insurance baseline reimbursement rate is $1153.46. This represents the customary allowable amount established across standard fee schedules.

Home/Procedures/Partial Removal of Spine Bone with Re-exploration

CPT 63042Medical Service

Partial Removal of Spine Bone with Re-exploration

Partial removal of spine bone with re-exploration, release of lower spinal cord or nerves and/or removal of disc, 1 interspace. Clinical pricing breakdown and utilization metrics across 80 practicing doctors nationwide.

$3935.84

Peer Median Charge

Gross billed rate

$1153.46

Standard Baseline

Customary allowable

3.4x

National Markup

Charge vs baseline

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $3935.84. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $1153.46 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 63042 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"