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CPT 63704: Repair of Myelomeningocele (lesion <5 cm)
Headline: CPT code 63704: Surgical repair of myelomeningocele (lesion <5 cm)
Lead: CPT code 63704 denotes the operative repair of a myelomeningocele—a severe form of spina bifida where the spinal cord and membranes herniate through a vertebral defect—when the lesion measures less than 5 cm. This code captures a high-complexity pediatric neurosurgical procedure with implications for inpatient surgical resource use, perioperative risk management, and long-term neurological outcomes.
Why it matters: Nationally, myelomeningocele repairs are critical, time-sensitive interventions that affect lifelong function and health care needs. Coding specificity for lesion size informs clinical documentation, case mix, and appropriate inpatient billing and quality measurement.
Payers covered: Analysis includes major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication explains the clinical scope of CPT code 63704, expected site-of-service and service type, common payer relationships, and where code-level specificity influences billing and utilization patterns. It highlights benchmarks and policy-relevant considerations such as inpatient surgical resource allocation, documentation elements tied to lesion size, and clinical context for coding decisions. Data not available in the input are clearly noted where applicable.
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Billing Code Overview
CPT code 63704 describes the surgical repair of a myelomeningocele—a severe form of spina bifida in which the spinal membrane and spinal cord protrude through a defect in the vertebral column—when the lesion diameter is less than 5 cm. The procedure addresses the congenital neural tube defect by closing the defect and repairing the exposed neural elements and surrounding tissues.
Service type: Surgical repair of congenital spinal defect (neurosurgical/craniofacial or pediatric neurosurgery operative procedure)
Typical site of service: Inpatient hospital operating room or specialized pediatric surgical center operating suite, given the complexity of the congenital repair and the need for perioperative monitoring and postoperative inpatient care.