Coding, claims and collections for spine surgeons, cranial and functional neurosurgery groups and hospital-based neurosurgical practices, done inside the systems you already run.
Neurosurgery revenue leaks inside the operative note: a second fusion level coded as one, a physician assistant assist never billed, co-surgeon claims that do not match, or a hospital outpatient cervical fusion done without Medicare prior authorization. A missed 22634 add-on costs $432.54 per case at 2026 Medicare national rates. Luxen codes every spine and cranial case from the signed op note and implant record, tracks prior authorization rules and works denials so your practice is paid for the surgery it performed.
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Neurosurgery billing services code and collect for spine and cranial surgery: fusion and decompression codes with their add-ons, instrumentation and grafts, co-surgeon and assistant modifiers, 90-day global periods and Medicare prior authorization. In 2026 Medicare pays a national $1,700.11 for a combined posterolateral and interbody lumbar fusion at one interspace (22633) before geographic adjustment.
We also bill the service lines around the surgeon: physician assistant and nurse practitioner assists with modifier AS, advanced practice clinic visits, ambulatory surgery center facility claims and neuromonitoring when a separate provider performs it. New surgeons and APPs need payer enrollment before their first case, and a lapsed re-credentialing held payments for a median of 47 days (Luxen billing reviews). Our provider credentialing team tracks every enrollment date.
Neurosurgery revenue is lost between the operative note and the claim. Dollar figures are 2026 Medicare national facility rates at the $33.4009 conversion factor, before geographic adjustment.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| Second fusion level not coded | 22633, 22634 | Two interspaces documented, add-on for the second level dropped | $432.54 | Op notes read level by level against billed units |
| Co-surgeons on one lumbar fusion | 22633, modifier 62 | Only one surgeon bills with modifier 62, so both claims pay wrong and need correction | $1,062.57 per surgeon (62.5% of $1,700.11) | Modifier 62 was missing from one co-surgeon claim on 13% of co-surgery cases, across 5,200 neurosurgery claims (Luxen claim audit) |
| Physician assistant assist not billed | 22633, modifier AS | Assistant named in the op note, no assist claim created | $231.21 (13.6% of $1,700.11) | Assistant fields in op notes matched to billed assists |
| Iliac crest graft coded as local autograft | 20937, 20936 | Separate-incision harvest reported as bundled local graft | $147.30 | Graft source and incision checked in every fusion note |
| Spinal navigation left off the claim | 61783 | Navigation used on an instrumented fusion but not charged | $207.42 | Navigation logs reconciled to charges |
| Hospital outpatient cervical fusion without prior authorization | 22551, 22552 | No affirmed Medicare request, so the surgeon claim is denied with the facility claim | $1,604.91 for one level | Authorization status checked before the case date |
A spine claim is a base code plus add-ons for each extra level, device and graft. Payments are 2026 Medicare national facility amounts at $33.4009 per RVU (CMS PFS relative value data).
| Code | What it reports | Global | 2026 national facility payment |
|---|---|---|---|
| 22551 | Anterior cervical discectomy and fusion, first interspace below C2 | 90 days | $1,604.91 |
| 22552 | Each additional cervical interspace | Add-on | $353.05 |
| 22612 | Posterior or posterolateral lumbar fusion, single interspace | 90 days | $1,467.64 |
| 22630 | Posterior interbody lumbar fusion, single interspace | 90 days | $1,510.72 |
| 22633 | Combined posterolateral and interbody lumbar fusion, single interspace | 90 days | $1,700.11 |
| 22634 | Each additional interspace with 22633 | Add-on | $432.54 |
| 63047 | Lumbar laminectomy, facetectomy and foraminotomy, single segment | 90 days | $1,065.49 |
| 22840 | Posterior non-segmental instrumentation, such as pedicle fixation across one interspace | Add-on | $668.35 |
| 22842 | Posterior segmental instrumentation, 3 to 6 vertebral segments | Add-on | $680.04 |
| 22853 | Interbody biomechanical device, each interspace | Add-on | $228.80 |
| 20937 | Morselized autograft through a separate incision | Add-on | $147.30 |
| 20936 | Local autograft from the same incision | Bundled (status B) | No separate payment |
Our neurosurgery medical coding team codes each case from the signed operative note, level by level, before the claim is built.
| Modifier | When it applies | Medicare payment |
|---|---|---|
| 62 | Two surgeons each perform distinct parts of one procedure | 62.5% of the fee schedule amount to each surgeon |
| 80 or 82 | A physician assists at surgery | 16% of the surgical amount; 82 in a teaching hospital only when no qualified resident is available |
| AS | A physician assistant, nurse practitioner or clinical nurse specialist assists | 85% of the 16% amount, which is 13.6% |
| Multiple procedures | Same surgeon, same session | 100% for the highest-paid procedure, 50% for the others; add-on codes are not reduced |
| 22 | Substantially greater work than usual | Regular fee schedule rate unless a concise statement and the operative report support more |
Sources: CMS MLN907166 global surgery booklet, Claims Processing Manual, Chapter 12, 42 CFR 414.52 and 42 CFR 415.190. Check the co-surgeon indicator: 22633 allows co-surgeons when the specialty requirement is met, while 22840 and 61510 need records showing why two surgeons were necessary (CMS PFS indicators).
The surgeon claim totals $3,130.00. A physician assistant assist with modifier AS adds 13.6%, or $425.68.
Traditional Medicare now requires prior authorization for parts of neurosurgery through two programs, on top of Medicare Advantage and commercial plan rules. Missing or invalid prior authorization caused 17% of denials (Luxen claim audit).
The WISeR Model runs from January 1, 2026 to December 31, 2031 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington (CMS Innovation Center). Practices in Texas, Ohio and New Jersey either request prior authorization or face pre-payment medical review.
| Service | Coverage rule | 2026 status |
|---|---|---|
| Cervical fusion | LCDs L39741, L39758, L39793 | In the model |
| Electrical nerve stimulators, including spinal cord stimulators | NCD 160.7 | In the model |
| Vagus nerve stimulation | NCD 160.18 | In the model |
| Induced lesions of nerve tracts | NCD 160.1 | In the model |
| Percutaneous vertebral augmentation | LCDs L38201, L34228, L35130 | In the model |
| Deep brain stimulation | NCD 160.24 | Delayed to a future notice |
| Percutaneous image-guided lumbar decompression | NCD 150.13 | Delayed to a future notice |
WISeR reviews hospital outpatient and ASC facility claims and office claims, and professional claims can be flagged when the facility claim is non-affirmed. Inpatient-only services, emergency services and codes already under the outpatient program are excluded (WISeR provider and supplier guide). Our eligibility and prior authorization team files and tracks both.
NCCI does not pay 63042 or 63047 with 22630 or 22633 at the same interspace, because those fusion codes already include the decompression (NCCI Policy Manual, Chapter IV). The denied 63047 line is $532.74 after the multiple procedure reduction. Decompression was billed at the fused interspace on 8% of lumbar fusion claims, across 5,200 neurosurgery claims (Luxen claim audit).
Medicare limits 69990 to listed cranial, spinal cord and peripheral nerve code ranges and says it should not be reported with other procedures even if a microscope is used (NCCI Policy Manual, Chapter VIII). Anterior cervical fusion 22551 is outside those ranges, so the $198.07 add-on is denied. 69990 was billed with anterior cervical fusion codes on 4% of anterior cervical fusion claims (Luxen claim audit).
A physician assisting at surgery is paid 16% of the surgical amount; a physician assistant, nurse practitioner or clinical nurse specialist billing with modifier AS is paid 85% of that, or 13.6% (42 CFR 414.52, 42 CFR 414.56). On 22633 that is $231.21, not $272.02. Coding and modifier errors caused 21% of denials (Luxen claim audit).
When a hospital outpatient cervical fusion has no affirmed Medicare request, claims related to that service, including the surgeon and anesthesia, are not paid (CMS OPD prior authorization operational guide). One level of 22551 is $1,604.91 to the surgeon. Surgeon claims for hospital outpatient cervical fusions were denied for missing prior authorization on 5% of Medicare cases (Luxen claim audit).
Medicare wants a concise statement of how the case differed from the usual plus the operative report (CMS Transmittal 11287); without them the claim pays the regular rate. Underpaid 22 claims go to our denials and AR recovery team with the op note attached. Appeals filed by Luxen were overturned 68% of the time (Luxen client data).
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
We work inside the systems your neurosurgery practice already runs. No migration and no new screens for surgeons.
We sign the BAA before access and code from the signed operative note and implant record, not the scheduling request.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Luxen client data, 38 client practices, Jan 2024 to Jun 2026:
Luxen billing reviews, 11 neurosurgery practices within 410 practice billing reviews, Jan 2025 to Jun 2026:
Co-surgeon, assistant, and staged-procedure details were not consistently reflected on complex surgical claims. Luxen reviewed each operative case, reduced related denials by 62%, and recovered $128,900.
Billing Director, hospital-based neurosurgery group
High-value cases were sitting unbilled while the operative note and implant record moved through separate approval queues. Luxen introduced a 48-hour case review and reduced outstanding unbilled surgery charges by $276,000.
Chief Operating Officer, multi-provider neurosurgical practice
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Surgical payment moved in 2026, and the proposed 2027 fee schedule would move it again. Comments on the 2027 proposal close September 14, 2026 (Federal Register).
| Change | Status | Effect on neurosurgery claims |
|---|---|---|
| Conversion factor $33.4009, up 3.26% | Final, January 1, 2026 | Raises fee schedule payments before RVU changes |
| Efficiency adjustment of -2.5% to work RVUs of non-time-based services | Final, January 1, 2026 | Surgical codes lose work RVUs: 22551 fell from 25.00 to 24.38. Office E/M codes are exempt |
| New add-on 63032, annular defect repair at one lumbar level | Final, January 1, 2026 | A new line to capture: 4.08 facility RVUs, about $136.28 |
| Modifier 54 for every 90-day global handed off, plus G0559 | Final, January 1, 2025 | Hand-offs to another practice for post-op care need 54 and 55 on the right claims |
| Conversion factor $32.84, down 1.68% | Proposed for 2027 | Lowers every Medicare payment if finalized |
| Same-day office E/M with a 0, 10 or 90-day global procedure | Proposed for 2027 | The more expensive service pays 100% and the other pays 50% |
Sources: CY 2026 PFS final rule fact sheet, CY 2025 PFS final rule fact sheet and CY 2027 PFS proposed rule fact sheet. We load new RVUs each January and flag contracts priced as a percentage of Medicare so underpayments are caught on the first remittance.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
Luxen charges 3% to 6% of collections, depending on case volume, payer mix and prior authorization workload. No setup or exit fee.
| Service line | Monthly collections | Luxen at 3% | Luxen at 6% |
|---|---|---|---|
| Spine surgery (fusion and decompression) | $108,500 | $3,255 | $6,510 |
| Cranial and stimulator procedures | $23,250 | $697.50 | $1,395 |
| Office and hospital E/M visits | $15,500 | $465 | $930 |
| Physician assistant assists (modifier AS) | $7,750 | $232.50 | $465 |
| Total | $155,000 | $4,650 | $9,300 |
| Cost | In-house | Luxen |
|---|---|---|
| Monthly | $12,245 | $4,650 to $9,300 |
| Annual | $146,940 | $55,800 to $111,600 |
| When a biller leaves | Open biller roles took a median 67 days to fill | No gap in coverage |
| Terms | Salaries, benefits and software | Month to month, 30 days notice |
Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data (Luxen billing reviews). This practice collects $1.86M a year.
| Partner type | Spine and cranial coding | Prior authorization work | Reporting | Terms |
|---|---|---|---|---|
| In-house biller | Depends on one person | Often handled by surgical schedulers | Built by your staff | Payroll and turnover |
| Generalist billing company | Office E/M focused | Often not included | Standard aging reports | Often annual terms |
| Specialty neurosurgery billing company | Surgical coding depth | Varies | Varies | Varies, some charge setup fees |
| Hospital or EHR vendor RCM | Built around facility workflows | Facility claims first | Inside the vendor platform | Tied to the hospital or software contract |
| Luxen | Certified coders for spine, cranial and stimulator cases | Included in eligibility and prior authorization work | Monthly denials, AR and case reconciliation | Month to month, 30 days notice |
Compare medical billing companies on these points, or see what full-service medical billing covers.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
Most charge a percentage of collections, so the fee moves with what the practice is paid. Luxen charges 3% to 6% of collections, month to month with 30 days notice and no setup or exit fee. For a spine practice collecting $155,000 a month, that is $4,650 to $9,300 a month.
Code only what the operative note documents. Each fusion interspace, instrumentation construct and graft source must be written in the note before it becomes a line such as 22634, 22842 or 20937. For modifier 22, Medicare also wants a concise statement of how the case differed from the usual and the operative report with the claim.
About 2 weeks from signed BAA to working claims, with first recovered payments in about 3 weeks. Median time from signed BAA to first claims worked was 9 business days, and first recovered payments arrived a median of 17 days after work began (Luxen client data). We start with open surgical cases and the oldest unpaid fusion and cranial claims.
Yes. We work inside Epic, Oracle Health, MEDITECH, athenaOne, NextGen, eClinicalWorks and AdvancedMD under a signed BAA, so surgeons keep their templates and screens. Among practice managers who changed EHR or practice management system in the past five years, 71% said collections dipped for at least six months after the switch (Luxen Practice Manager Survey 2026).
Yes, when the E/M visit happens the day before or the day of a 90-day global surgery and results in the first decision to operate, it is billed with modifier 57. Without modifier 57 that visit is treated as part of the global surgical package. Modifier 25 is for significant, separately identifiable visits on the day of minor procedures with 0 or 10-day globals.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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