CPT 63042 · Spinal Decompression · Medicare (NGS MAC)
Laminotomy Re-Exploration — Lumbar at Medicare (NGS MAC).
How Medicare (NGS MAC) approaches CPT 63042 (Laminotomy Re-Exploration — Lumbar) for prior-authorization review: at last review on 2026-05-02, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-02
Criteria summary
High-level themes from the Medicare (NGS MAC) policy of record for CPT 63042. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
See the full Medicare (NGS MAC) criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →