CPT 22867Surgery

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CPT 22867 covers the surgical insertion of a device to stabilize the spine along with removing pressure from compressed nerves or spinal cord. This is an add-on code used with primary spinal fusion procedures.

Showing rates for

National Average

Base Medicare rate

$1,045.44

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

PE RVU (NF)

12.93

MP RVU

4.39

Total RVU

32.32

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

NCCI bundling edits

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Billing tips

Always bill 22867 per spinal level treated; this code can be reported multiple times for multilevel procedures
Impact: Billing 3 levels instead of 1 increases reimbursement from $1045.44 to $3136.32
Verify the primary procedure code supports 22867 as an add-on; it must be billed with fusion codes 22532-22534, 22558, 22585, 22612, 22630, 22633-22634, 22800-22812
Impact: Prevents automatic denial; ensures payment of full $1045.44 per level
Document both the stabilization device insertion AND the decompression component in operative notes; both elements are required for 22867
Impact: Missing decompression documentation causes denials of entire $1045.44 charge per level
Submit image guidance documentation separately if applicable; fluoroscopy is typically included but advanced imaging may warrant additional codes
Impact: Potential additional $100-300 in reimbursement when properly documented and separately billable
Check LCD/NCD policies for device-specific coverage requirements; some interspinous devices have specific FDA-approved indications
Impact: Off-label use denials can result in 100% payment loss ($1045.44+ per level)
Bill 22867 with correct units on claim form when multiple levels treated; some payers require units while others require separate line items
Impact: Incorrect unit reporting can reduce payment by 50% or more on multilevel cases

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22867 in 2025?

The 2025 Medicare national average reimbursement for CPT 22867 is $1045.44 for both facility and non-facility settings. This rate is based on 32.32 total RVUs (15.00 work RVU, 12.93 PE RVU, 4.39 MP RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 22867 be billed alone or does it require a primary procedure code?

CPT 22867 is an add-on code and cannot be billed alone. It must be reported with a primary spinal procedure code such as 22532-22534, 22558, 22585, 22612, 22630, 22633-22634, or 22800-22812. Billing 22867 without a qualifying primary code will result in automatic denial.

How many times can CPT 22867 be billed during a single surgical session?

CPT 22867 can be billed multiple times per operative session, once for each spinal level where the stabilization device with decompression is performed. Documentation must clearly identify each distinct level treated. For example, a three-level procedure would report 22867 three times.

What documentation is required to bill CPT 22867 successfully?

Required documentation includes the specific spinal level(s) treated, device type and specifications, image guidance used, detailed description of the decompression performed (not just stabilization), medical necessity justification, and confirmation the procedure was performed in addition to a primary spinal surgery. Both stabilization device insertion AND decompression must be clearly documented.

What is the difference between CPT 22867 and 22869?

CPT 22867 includes both insertion of the stabilization/distraction device AND decompression, while 22869 is for device insertion only without decompression. If decompression is performed, 22867 is the appropriate code. Using 22869 when decompression was performed results in undercoding and lost revenue of approximately $200-400 per level.

Do I need modifier 51 when billing CPT 22867 with other procedures?

No, modifier 51 is generally not required for CPT 22867 because it is an add-on code designated as modifier 51 exempt. Add-on codes are not subject to multiple procedure payment reductions. However, some payers may have specific billing requirements, so verify individual payer policies.

What are common denial reasons for CPT 22867 and how can they be prevented?

Common denials include: billing without a primary procedure code (always bill with qualifying primary code), insufficient documentation of decompression (document both device insertion AND decompression elements), medical necessity denials (provide preoperative imaging and conservative treatment failure documentation), and bundling issues (use modifier 59 when appropriate for distinct levels). Preventing denials requires complete operative notes documenting all required elements for each level treated.