CPT 22630Surgery

Arthrd pst tq 1ntrspc lum

CPT 22630 covers posterior lumbar interbody fusion (PLIF), a spinal surgery where a surgeon removes a damaged disc in the lower back and fuses two vertebrae together using bone graft material inserted from the back of the spine.

Showing rates for

National Average

Base Medicare rate

$1,544.22

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

22.09

PE RVU (NF)

17.8

MP RVU

7.85

Total RVU

47.74

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Always use add-on code 22632 for each additional interspace beyond the first level in the same operative session
Impact: Each additional level adds approximately $1,200-$1,400 in reimbursement; billing 22630 twice instead of 22630 + 22632 will result in denial
Bill instrumentation separately using 22842 (posterior segmental instrumentation, 3-6 vertebral segments) when hardware is placed
Impact: Adds approximately $2,500-$3,500 to total reimbursement; must document specific hardware placed and levels instrumented
Report bone graft procurement separately if autograft is harvested from separate incision (20936 for structural, 20937 for morselized, or 20938 for iliac crest)
Impact: Adds $400-$800 depending on graft type; local graft taken through same incision is included in 22630 and should not be separately billed
Verify commercial payer policies regarding facility vs. non-facility designation; most require inpatient or hospital outpatient setting
Impact: Both facility and non-facility rates are $1,544.22 for Medicare in 2025, but commercial contracts may vary significantly; ASC rates are typically lower
Document the specific interspace treated (e.g., L4-L5, L5-S1) in both the operative report and on the claim to prevent denials for lack of specificity
Impact: Prevents denials and requests for medical records; specific anatomic documentation reduces audit risk by approximately 30-40%
Bundle fluoroscopy and imaging guidance into the surgical code; do not separately bill 77003 for fluoroscopic guidance during fusion
Prevents NCCI edit denials; separately billing bundled services triggers automatic denials and potential audit flags

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 22630?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement for CPT 22630 in 2025?

The 2025 Medicare national average payment for CPT 22630 is $1,544.22 for both facility and non-facility settings, based on 47.74 total RVUs and a conversion factor of 32.3465. This represents the professional component only; facility fees are billed separately by the hospital or ASC.

Can I bill CPT 22630 for multiple levels of lumbar fusion?

No. CPT 22630 is only reported once for the first lumbar interspace treated. Each additional level requires add-on code 22632, which should be reported for the second, third, and subsequent levels treated during the same operative session.

What is the difference between CPT 22630 and 22633?

CPT 22630 describes posterior or posterolateral arthrodesis of a single lumbar interspace, while 22633 describes a combined posterior/posterolateral approach with a posterior interbody technique including laminectomy at a single lumbar segment. Code 22633 involves more extensive work including decompression and has higher RVUs.

How do I bill for instrumentation with CPT 22630?

Posterior segmental instrumentation is reported separately using code 22842 (for 3-6 vertebral segments) or 22843 (for 7-12 segments). These codes are reported in addition to 22630 and require documentation of the specific hardware placed, levels instrumented, and attachment technique.

Does CPT 22630 include bone graft material?

Local bone graft obtained through the same incision is included in 22630. However, bone graft harvested from a separate incision (such as iliac crest autograft) may be reported separately using codes 20936-20938. Allograft or bone graft substitutes are typically included unless payer policy allows separate reporting.

What documentation is required to support medical necessity for CPT 22630?

Required documentation includes: diagnostic imaging (MRI or CT) showing pathology, clinical notes documenting symptoms and functional limitations, evidence of at least 6 months of failed conservative treatment (physical therapy, medications, injections), correlation between imaging findings and clinical symptoms, and operative indication clearly stated in the surgical report.

What is the global period for CPT 22630?

CPT 22630 has a 90-day global period. All routine postoperative care related to the fusion procedure within 90 days is included in the reimbursement. Unrelated E/M services require modifier 24, and complications requiring return to OR require modifier 78 (related) or 79 (unrelated to original procedure).