CPT 22858Surgery

Tot disc arthrp 2nd lvl crv

CPT 22858 covers the additional cervical (neck) level when a surgeon replaces a second damaged spinal disc with an artificial disc during the same operation. This is an add-on code that cannot be billed alone.

Showing rates for

National Average

Base Medicare rate

$492.64

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

8.4

PE RVU (NF)

4.27

MP RVU

2.56

Total RVU

15.23

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

NCCI bundling edits

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Billing tips

Always bill 22858 with primary code 22856 (first cervical level total disc arthroplasty); 22858 cannot be billed as a standalone code
Impact: Prevents automatic denial; ensures proper payment of $492.64 per additional level when correctly paired
Report 22858 for each additional cervical level beyond the first (e.g., for 3-level arthroplasty, bill 22856 once and 22858 twice)
Impact: Maximizes reimbursement; billing two units of 22858 yields $985.28 additional revenue for 3-level procedure
Document specific interspace levels treated (e.g., C4-C5, C5-C6) in operative report with clear identification of which level is primary versus additional
Impact: Reduces medical necessity denials and audit risk; clear level identification supports full payment for all levels billed
Verify FDA-approved artificial disc device used and document manufacturer/model in operative note, as some payers have coverage limitations for specific devices
Impact: Prevents device-related denials; non-approved devices may result in denial of entire $492.64 claim
Submit procedure with diagnosis codes supporting multilevel pathology (M50.020-M50.023 for cervical disc displacement at multiple levels)
Impact: Strengthens medical necessity; specific multilevel diagnosis codes reduce likelihood of denial for additional levels
For ASC settings, confirm 22858 is on facility's approved procedure list, as some ASCs may not be approved for multilevel disc arthroplasty
Impact: Prevents setting-of-service denials; facility and professional components both paid at $492.64 when setting is appropriate

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22858 in 2025?

The 2025 Medicare national average reimbursement for CPT 22858 is $492.64 for both facility and non-facility settings. This rate is based on 15.23 total RVUs (8.4 work RVU, 4.27 PE RVU, 2.56 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 22858 be billed alone or does it require a primary code?

CPT 22858 cannot be billed alone; it is an add-on code that must be reported with primary code 22856 (total disc arthroplasty, anterior approach, including discectomy to prepare interspace, single interspace, cervical). You bill 22856 for the first level and 22858 for each additional cervical level.

How many times can I bill CPT 22858 for a multilevel cervical disc replacement?

You can bill 22858 once for each additional cervical level beyond the first. For example, a 3-level cervical disc arthroplasty would be coded as 22856 x1 and 22858 x2. There is no absolute limit, but medical necessity must be documented for each level, and most payers question procedures beyond 2-3 levels.

What modifiers are commonly used with CPT 22858?

Common modifiers include 59 (for non-adjacent levels to prevent bundling), 22 (for increased procedural complexity with supporting documentation), and 62 (for co-surgeons). Modifier 51 is generally not needed as 22858 is modifier 51 exempt being an add-on code.

What documentation is required to support billing CPT 22858?

Required documentation includes specific identification of each cervical interspace level treated, clear designation of primary versus additional levels, description of disc removal and device placement at each level, artificial disc manufacturer and model details, intraoperative imaging confirmation, and medical necessity justification for multilevel arthroplasty.

What are the most common denial reasons for CPT 22858?

Common denials include billing 22858 without primary code 22856, insufficient documentation of medical necessity for multilevel procedure, lack of specific level identification in operative notes, and use of artificial disc devices not covered by specific payers or not FDA-approved for cervical use.

What is the difference between CPT 22858 and cervical fusion add-on codes?

CPT 22858 is specifically for additional levels of cervical artificial disc replacement (arthroplasty), while codes like 22552 or 22585 are for additional levels of cervical fusion. Arthroplasty preserves motion at the treated level, whereas fusion eliminates motion. The codes cannot be used interchangeably and represent fundamentally different surgical approaches.