Summary & Overview
CPT 63706: Myelomeningocele Repair, Defect >5 cm
CPT code 63706 represents surgical repair of a large myelomeningocele (>5 cm), a severe form of spina bifida where the spinal cord and meninges protrude through a vertebral defect. This procedure is a critical neurosurgical intervention typically performed in an inpatient hospital or specialized pediatric neurosurgery center to prevent infection, preserve neurologic function, and manage associated anomalies. Nationally, codes for complex congenital neural tube defect repairs matter for bundled payments, quality measurement, and specialized surgical capacity.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused briefing that outlines the procedural intent, typical site of service, and the administrative context for use of the code. The publication provides benchmarks for utilization and allowed services, discusses relevant policy and payer coverage patterns, and summarizes clinical context that coders and administrators need to apply the code correctly. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 63706 describes a 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. The code applies when the diameter of the myelomeningocele is larger than 5 cm.
Service type: Open neurosurgical repair of congenital spinal dysraphism
Typical site of service: Inpatient hospital or specialized pediatric neurosurgery center operating room
Clinical & Coding Specifications
Clinical Context
A newborn infant is delivered with a large lumbosacral myelomeningocele measuring greater than 5 cm in diameter, exposed at the posterior midline with cerebrospinal fluid leakage and no intact skin covering. The multidisciplinary neonatal care team (neonatology, pediatric neurosurgery, pediatric anesthesiology, and nursing) performs initial stabilization in the NICU, protects the sac with sterile saline dressings, administers prophylactic antibiotics, and evaluates for associated anomalies (Chiari II malformation, hydrocephalus). After imaging (cranial ultrasound or MRI) and cardiovascular/respiratory optimization, the infant is taken to the operating room for primary closure and repair of the myelomeningocele. The procedure involves neural tissue assessment, placode repositioning if feasible, multilayer dural and fascial closure, and soft-tissue reconstruction; the large defect (>5 cm) may require rotation flaps or grafts. Postoperative care includes monitoring for CSF leak, infection, wound integrity, neurological function, and long-term planning for hydrocephalus management (e.g., ventricular shunt placement) and bladder/bowel dysfunction evaluation. Typical site of service is an inpatient tertiary pediatric hospital with pediatric neurosurgery capability. Service type is surgical repair—open neonatal neurosurgical congenital defect repair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure performed at the correct hospital/ASC | Use for standard reporting when no other institutional modifier applies |