CPT 22861Surgery

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CPT code 22861 covers the surgical revision or replacement of an artificial disc in one level of the cervical spine (neck). This is typically performed when a previously implanted artificial disc has failed, worn out, or is causing complications.

Showing rates for

National Average

Base Medicare rate

$2,290.78

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

33.36

PE RVU (NF)

23.73

MP RVU

13.73

Total RVU

70.82

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

NCCI bundling edits

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Billing tips

Document the specific reason for revision in detail (device failure type, imaging findings, patient symptoms) and reference the original arthroplasty date and CPT code used
Impact: Reduces denial risk by 60-70%; medical necessity denials are the top reason for rejection of revision arthroplasty claims
Code 22861 is per interspace; if revising multiple levels, report additional levels with add-on code 22862 (+$1900-2100 per additional level)
Impact: Proper multi-level coding can increase total reimbursement to $4200-4400 for two-level revisions
Submit modifier 22 claims with detailed operative report highlighting specific complexities: minutes of lysis of adhesions, vascular repair, dural tear repair, or removal of ectopic bone
Impact: Successfully appealed modifier 22 claims can add $450-1100 to base reimbursement; include comparison to typical case time
Verify the patient's original artificial disc surgery wasn't within the global period of another spine procedure to avoid bundling issues
Impact: Prevents automatic denials; if within global period, modifier 78 or 79 documentation is essential
Do not separately bill removal of the failed device (included in 22861); removal is considered integral to the revision arthroplasty
Impact: Prevents unbundling denials and potential fraud flags; hardware removal codes 22864/22865 should not be reported with 22861
Use ICD-10 codes that specifically indicate mechanical complication of prosthetic device (T84.0xx series) rather than generic pain codes
Improves first-pass approval rate by 40-50%; links medical necessity directly to device failure

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22861 in 2025?

The 2025 Medicare national average reimbursement for CPT 22861 is $2290.78 for both facility and non-facility settings. This is based on 70.82 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can CPT 22861 be billed with hardware removal codes 22864 or 22865?

No, CPT 22861 includes removal of the failed artificial disc device as part of the revision procedure. Billing hardware removal codes separately creates unbundling issues and will result in denials. If removal is extraordinarily complex, consider modifier 22 with documentation instead.

How many RVUs is CPT code 22861 worth?

CPT 22861 has 70.82 total RVUs for 2025, consisting of 33.36 work RVUs, 23.73 practice expense RVUs, and 13.73 malpractice RVUs. This high RVU value reflects the complexity of cervical artificial disc revision surgery.

What documentation is required to bill CPT 22861 for artificial disc revision?

Required documentation includes the original arthroplasty details, imaging demonstrating device failure or complication, clinical justification for revision, operative report detailing removal and revision technique, and ICD-10 codes indicating mechanical complication (T84.0xx series). Medical necessity must be clearly established.

How do you bill for multiple level cervical disc revisions?

Report CPT 22861 for the first interspace revised, then add CPT 22862 for each additional interspace. Each level must be separately documented with specific findings justifying revision at that level.

What modifiers are commonly used with CPT 22861?

Common modifiers include 22 (increased procedural services due to complexity), 62 (co-surgeons when two specialists collaborate), and 78 (return to OR during global period). Modifier 22 requires detailed documentation of unusual complexity to justify additional reimbursement.

What are the most common denial reasons for CPT 22861?

The most common denials are lack of medical necessity documentation, unbundling with hardware removal codes, billing during global period without proper modifiers, and insufficient evidence of device failure. Appeals should include comprehensive imaging, operative notes, and device complication documentation.