CPT 22865Surgery

Rmvl tot arthrp 1ntrspc lmbr

CPT code 22865 covers the surgical removal of a previously implanted artificial disc (total disc arthroplasty) from one spinal level in the lower back (lumbar spine). This is a revision surgery performed when an artificial disc replacement fails or causes complications.

Showing rates for

National Average

Base Medicare rate

$2,238.05

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

31.75

PE RVU (NF)

24.38

MP RVU

13.06

Total RVU

69.19

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

NCCI bundling edits

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Billing tips

Document the specific reason for prosthesis removal with diagnostic evidence (imaging, lab results for infection, failed ROM studies) to support medical necessity
Impact: Prevents denials for lack of medical necessity which account for 35-40% of initial claim rejections for this code
Clearly document the interspace level removed (e.g., L4-L5) and distinguish from any additional fusion or instrumentation performed, which require separate codes
Impact: Proper level documentation prevents downcoding and supports accurate RVU assignment worth $2238.05; bundling errors can result in loss of $1000+ in additional procedure reimbursement
For cases requiring modifier 22, include operative time, blood loss, and specific technical challenges in documentation; consider submitting operative report with initial claim
Impact: Successful modifier 22 appeals can increase reimbursement by $447-$1119 (20-50% increase) but approval rate is only 30% without comprehensive documentation
Verify that the original arthroplasty was coded as 22857 or 0163T; confirm device manufacturer and lot number in operative report for tracking and potential manufacturer-related failures
Impact: Establishes procedure history and may support appeals; device tracking may be required for FDA reporting and manufacturer warranty coverage affecting patient out-of-pocket costs
Do not bundle bone graft harvesting (20936-20938) or structural allografts (20930-20931) if performed separately; these are separately reportable with 22865
Impact: Recovers additional $200-$800 in legitimate reimbursement often left on the table due to incorrect bundling assumptions

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22865 in 2025?

The 2025 Medicare national average reimbursement for CPT 22865 is $2238.05 for both facility and non-facility settings. This is based on a total RVU of 69.19 multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location (GPCI adjustments) and payer-specific fee schedules.

Can CPT 22865 be billed with fusion codes on the same date of service?

Yes, CPT 22865 can be reported with fusion codes such as 22558, 22585, or 22630 when both prosthesis removal and fusion are performed at the same operative session. The procedures are distinct and separately reportable, though modifier 59 may be required to prevent bundling denials. Comprehensive documentation must clearly describe both procedures as separate and medically necessary services.

How many RVUs is CPT code 22865 worth in 2025?

CPT 22865 has a total RVU value of 69.19 in 2025, consisting of 31.75 work RVUs, 24.38 practice expense RVUs, and 13.06 malpractice RVUs. This high RVU value reflects the complexity and risk associated with removing a failed lumbar artificial disc prosthesis.

What diagnosis codes support medical necessity for CPT 22865?

Common supporting ICD-10 codes include T84.050A-T84.059A (mechanical complication of internal joint prosthesis of spine), M96.1 (postlaminectomy syndrome), T84.60XA-T84.69XA (infection of internal joint prosthesis), M46.26-M46.27 (osteomyelitis of vertebra, lumbar/lumbosacral), and M99.03 (segmental dysfunction of lumbar region). Documentation must clearly link the diagnosis to the need for prosthesis removal.

Is CPT 22865 a unilateral or bilateral code?

CPT 22865 is neither unilateral nor bilateral; it describes removal of total disc arthroplasty at one interspace in the lumbar spine. The code is reported once per interspace level removed. If prostheses from multiple interspaces are removed, report 22865 for the first level and add-on code(s) for additional levels if available and appropriate per CPT guidelines.

When should modifier 22 be used with CPT 22865?

Modifier 22 should be appended to CPT 22865 when the prosthesis removal requires substantially greater work than typical due to extensive scar tissue, prosthesis ingrowth, difficult extraction requiring specialized techniques, excessive blood loss, or complex anatomy from multiple previous surgeries. Documentation must include specific details of increased complexity, additional operative time (typically 50%+ over usual), and technical challenges encountered to support the 20-50% reimbursement increase requested.

What is the global period for CPT code 22865?

CPT 22865 carries a 90-day global surgical period. This means routine postoperative care for 90 days following the procedure is included in the reimbursement and cannot be separately billed. Any complications or unrelated services during this period require appropriate modifiers (24, 78, 79) to receive separate payment. The global period includes all preoperative visits one day before surgery through 90 days postoperatively.