CPT 61863
Global 090 ActiveImplant neuroelectrode
CPT 61863 Billing & Documentation Guide
CPT code 61863 (Implant neuroelectrode) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 20.19, a non-facility practice expense RVU of 16.07, and a malpractice RVU of 8.53, a total non-facility RVU of 44.79 and facility RVU of 44.79. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1492.17, though rates vary from $1276.33 to $1953.66 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 61863, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 61863 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 61863 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 61863
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 20.19 | 20.19 |
| Practice Expense RVU | 16.07 | 16.07 |
| Malpractice RVU | 8.53 | 8.53 |
| Total RVU | 44.79 | 44.79 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 61863
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $1488.17 | $1488.17 | $1426.82 - $1675.25 | 29 |
| Florida | $1767.53 | $1767.53 | $1615.72 - $1953.66 | 3 |
| Georgia | $1528.33 | $1528.33 | $1492.76 - $1563.9 | 2 |
| Illinois | $1739.82 | $1739.82 | $1609.73 - $1872.39 | 4 |
| Michigan | $1579.39 | $1579.39 | $1486.08 - $1672.69 | 2 |
| North Carolina | $1357.21 | $1357.21 | $1357.21 - $1357.21 | 1 |
| New York | $1692.49 | $1692.49 | $1384.57 - $1884.8 | 5 |
| Ohio | $1451.61 | $1451.61 | $1451.61 - $1451.61 | 1 |
| Pennsylvania | $1510.75 | $1510.75 | $1436.34 - $1585.16 | 2 |
| Texas | $1471.15 | $1471.15 | $1427.49 - $1604.79 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 61863
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 61863 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0082T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0282T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0283T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0333T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0398T | Column 1 (primary), can be billed with modifier | No | Mutually exclusive procedures |
| 0464T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 61863
What does CPT code 61863 mean? +
CPT code 61863 represents: Implant neuroelectrode. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 090.
What is the Medicare reimbursement for CPT 61863? +
The 2026 Medicare national average non-facility payment for CPT 61863 is $1492.17. Rates range from $1276.33 to $1953.66 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 61863? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 61863? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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