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CPT code 22864 covers the surgical removal of a previously implanted artificial disc replacement device from one level of the cervical spine (neck region). This is a revision procedure performed when the original disc replacement has failed or caused complications.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document the specific level (C3-C4, C4-C5, etc.) and type of arthroplasty device being removed with manufacturer and model information
Impact: Prevents denials for lack of specificity and supports medical necessity; can prevent $2,046 claim rejection
Code separately for each interspace when removing devices from multiple levels; 22864 is per interspace, use +22865 for additional levels
Impact: Each additional level adds significant reimbursement; failure to code multiple levels can result in $2,000+ underpayment per missed level
When removal is performed with concurrent fusion or instrumentation, ensure proper sequencing and modifier use to prevent bundling denials
Impact: Proper sequencing maximizes reimbursement; incorrect bundling can reduce total payment by 30-50% ($600-$1,000+ loss)
Obtain and document pre-authorization for revision arthroplasty removal procedures as most payers classify this as a high-cost, complex surgery
Impact: Lack of pre-authorization can result in complete claim denial of $2,046+ and delay in payment by 60-90 days during appeal
Use modifier 22 with detailed operative report when excessive scar tissue, vascular injury risk, or anatomical complexity significantly increases work
Impact: Successful modifier 22 claims can increase payment by $400-$1,000; requires submission of operative notes and comparative documentation
Verify that diagnostic imaging (X-rays, CT, MRI) demonstrating device failure or complications is documented within 30 days of surgery
Impact: Missing recent imaging can trigger medical necessity denials; ensures the $2,046 claim is supported by objective evidence
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