CPT 63685
Global 010 ActiveIns/rplc spi npg/rcvr pocket
CPT 63685 Billing & Documentation Guide
CPT code 63685 (Ins/rplc spi npg/rcvr pocket) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 5.06, a non-facility practice expense RVU of 3.43, and a malpractice RVU of 1.05, a total non-facility RVU of 9.54 and facility RVU of 9.54. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $322.05, though rates vary from $285.48 to $394.85 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 63685, 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 63685 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 63685 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 63685
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 5.06 | 5.06 |
| Practice Expense RVU | 3.43 | 3.43 |
| Malpractice RVU | 1.05 | 1.05 |
| Total RVU | 9.54 | 9.54 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 63685
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 | $329.65 | $329.65 | $316.24 - $371.6 | 29 |
| Florida | $352.23 | $352.23 | $331.24 - $376.97 | 3 |
| Georgia | $320.52 | $320.52 | $313.01 - $328.03 | 2 |
| Illinois | $347.32 | $347.32 | $328.42 - $365.82 | 4 |
| Michigan | $325.95 | $325.95 | $313.2 - $338.69 | 2 |
| North Carolina | $298.31 | $298.31 | $298.31 - $298.31 | 1 |
| New York | $352.51 | $352.51 | $302.5 - $381.17 | 5 |
| Ohio | $308.96 | $308.96 | $308.96 - $308.96 | 1 |
| Pennsylvania | $320.24 | $320.24 | $307.32 - $333.15 | 2 |
| Texas | $315.3 | $315.3 | $305.84 - $332.38 | 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 63685
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 63685 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 01935 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01936 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01937 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01938 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01939 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01940 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01941 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 01942 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 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 |
Frequently Asked Questions, CPT 63685
What does CPT code 63685 mean? +
CPT code 63685 represents: Ins/rplc spi npg/rcvr pocket. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 010.
What is the Medicare reimbursement for CPT 63685? +
The 2026 Medicare national average non-facility payment for CPT 63685 is $322.05. Rates range from $285.48 to $394.85 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 63685? +
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 63685? +
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 July 17, 2026.
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