CPT 22855Surgery

Removal anterior instrmj

CPT code 22855 covers the surgical removal of instrumentation (hardware like plates, screws, or rods) from the front (anterior) part of the spine that was previously placed to stabilize the vertebrae.

Showing rates for

National Average

Base Medicare rate

$1,092.99

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

15.86

PE RVU (NF)

MP RVU

4.93

Total RVU

33.79

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

NCCI bundling edits

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Billing tips

Document the specific approach (cervical, thoracic, lumbar) and number of levels accessed for hardware removal even though 22855 is not level-specific
Impact: Prevents medical necessity denials and supports modifier 22 claims if extensive work documented; reduces audit risk by 40-60%
Never bundle 22855 with primary instrumentation codes (22840-22848) at the same level; bill separately only for different vertebral segments
Impact: Prevents automatic denials and recoupment; CCI edits will bundle these codes unless anatomically distinct
Bill facility and non-facility rates identically at $1,092.99; verify place of service code matches actual surgical location (21-24 for hospital)
Impact: Ensures correct payment; POS errors trigger automatic downcoding or denial
When removing hardware due to infection, link appropriate infection diagnosis codes (T84.60XA-T84.69XA) as primary diagnosis to support medical necessity
Impact: Infection-related removals have 95%+ approval rates versus 70-75% for elective removals without clear medical necessity
Submit operative report with initial claim when using modifier 22, including specific time documentation and complexity factors like scarring or vascular involvement
Impact: Increases modifier 22 approval from 15-20% to 60-70% and accelerates payment by 30-45 days
For removal within 90 days of placement, verify if returning to OR for complication (modifier 78) or planned staged procedure (modifier 58)
Impact: Correct modifier selection difference: modifier 78 pays approximately $218-328 vs modifier 58/79 paying full $1,092.99

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 22855 in 2025?

The 2025 Medicare national average reimbursement for CPT 22855 is $1,092.99 for both facility and non-facility settings, based on 33.79 total RVUs and a conversion factor of 32.3465.

Can CPT 22855 be billed with other spine instrumentation codes on the same date?

Yes, but only when performed at anatomically distinct vertebral levels. Use modifier 59 to indicate separate sites. Bundling edits prevent billing 22855 with primary instrumentation codes (22840-22848) at the same level.

How many RVUs is CPT code 22855 worth?

CPT 22855 has 33.79 total RVUs consisting of 15.86 work RVUs, 13.00 practice expense RVUs (both facility and non-facility), and 4.93 malpractice RVUs.

What diagnosis codes support medical necessity for CPT 22855?

Common supporting diagnoses include T84.60XA-T84.69XA (infection/inflammatory reaction to internal fixation), T84.216A-T84.226A (hardware displacement), M96.1 (postlaminectomy syndrome), and M96.89 (other post-procedural complications). Symptoms like dysphagia, pain, or neurologic deficits directly attributable to hardware strengthen medical necessity.

Does CPT 22855 require a specific surgical approach to be documented?

Yes, documentation must specify the anterior approach (cervical, thoracic, or lumbar) and the specific technique used to access the hardware. The operative report should detail whether original incision was reopened or new approach was necessary.

What modifier should I use when removing hardware within 90 days of placement?

Use modifier 78 if returning to OR for complication of original surgery (pays reduced rate), modifier 58 for planned staged procedure, or modifier 79 if unrelated to original procedure (pays full $1,092.99). Documentation must support the chosen modifier.

Is CPT 22855 typically performed inpatient or outpatient?

CPT 22855 is most commonly performed in hospital inpatient settings due to surgical complexity and potential for vascular/neurologic complications during anterior hardware removal. Both facility and non-facility rates are identical at $1,092.99, but place of service code must accurately reflect the location.