CPT 22848Surgery

Insert pelv fixation device

CPT code 22848 covers the insertion of a pelvic fixation device during spinal fusion surgery, which anchors spinal instrumentation to the pelvis. This is an add-on procedure performed alongside major spinal fusion surgeries to provide additional stability.

Showing rates for

National Average

Base Medicare rate

$349.02

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

5.99

PE RVU (NF)

3.08

MP RVU

1.72

Total RVU

10.79

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

NCCI bundling edits

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Billing tips

Always bill 22848 with the appropriate primary spinal fusion code (22800-22819 series) as this is an add-on code and cannot be reported alone
Impact: Prevents automatic denial; ensures the $349.02 reimbursement is processed correctly as supplemental to primary procedure
Document the specific pelvic fixation device used (manufacturer, type, iliac screw specifications) and medical necessity for pelvic extension in the operative report
Impact: Reduces denial risk by 60-70% and supports medical necessity during audits or appeals
Bill per pelvic fixation construct, not per screw - one unit of 22848 covers the entire pelvic fixation device insertion regardless of number of iliac screws used
Impact: Prevents overbilling denials and recoupment; correct unit reporting ensures compliant $349.02 payment
Verify that the primary fusion procedure extends to or includes the sacrum (S1 or below) as pelvic fixation is typically only appropriate with sacral/pelvic fusion
Impact: Ensures medical necessity is met; inappropriate use with upper lumbar-only fusions results in 85%+ denial rate
When bilateral pelvic fixation is performed, append modifier 50 and ensure operative notes clearly document fixation to both iliac bones
Impact: Captures additional $174.51 in reimbursement (total $523.53) for bilateral work when supported by documentation
Do not separately bill for bone graft harvesting from ilium when performing pelvic fixation at the same site; use appropriate bundling
Impact: Avoids unbundling denials and compliance issues that could trigger audits and potential $1,000+ penalties per occurrence

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22848 in 2025?

The 2025 Medicare national average reimbursement for CPT 22848 is $349.02 for both facility and non-facility settings. This is based on 10.79 total RVUs (5.99 work RVU, 3.08 practice expense RVU, 1.72 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 22848 be billed alone or does it require a primary procedure code?

CPT 22848 cannot be billed alone. It is an add-on code that must be reported with a primary spinal arthrodesis (fusion) procedure code from the 22800-22819 series. Billing 22848 without an appropriate primary fusion code will result in automatic denial.

How many units of 22848 should I bill for bilateral pelvic fixation?

Bill one unit of 22848 with modifier 50 for bilateral pelvic fixation. Do not bill two separate units. The code represents the pelvic fixation construct, and modifier 50 indicates the bilateral nature of the procedure, typically resulting in 150% reimbursement.

What is the difference between CPT 22848 and other spinal instrumentation codes?

CPT 22848 specifically covers insertion of pelvic fixation devices (iliac screws/bolts) that anchor spinal instrumentation to the pelvis. This is distinct from standard segmental instrumentation codes (22842-22844) which cover instrumentation between vertebrae. Code 22848 is used when fixation must extend beyond the sacrum to the iliac bones for additional stability.

Do I need modifier 51 when billing CPT 22848 with multiple other procedures?

No, modifier 51 should not be appended to CPT 22848. As an add-on code, it is exempt from multiple procedure payment reductions. Add-on codes are designed to be billed with primary procedures without modifier 51, and the full reimbursement of $349.02 applies regardless of other procedures performed.

What documentation is required to support medical necessity for CPT 22848?

Documentation must include: operative report detailing pelvic fixation device insertion with anatomic specifics, clinical rationale for extending fixation to pelvis (long construct, deformity, revision, poor bone quality), fusion levels including sacral involvement, device specifications, and whether bilateral or unilateral fixation was performed. Preoperative imaging and biomechanical justification strengthen medical necessity.

Can CPT 22848 be billed for sacral screw placement or only iliac fixation?

CPT 22848 is specifically for pelvic fixation devices inserted into the ilium (pelvic bone), not for standard sacral screws. Sacral screw placement is included in the segmental instrumentation codes (22842-22844). Only when fixation extends from the spine to the iliac wings or pelvic bones should 22848 be reported.