CPT 22116 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 62 - Co-Surgeons |
| Complexity Level | Low |
National average reimbursement for CPT 22116 by major payers:
$189.76
$193.86
$229.11
$232.56
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 22116 | ||||||
United | 22116 | $312.00 | 1780851691 - PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C. | 911394965 - PACIFIC CATARACT AND LASER INSTITUTE, INC., PC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $820.00 | 1215283866 - EC LASER AND SURGERY INSTITUTE OF WI, LLC | 454182045 - (WI) EC LASER AND SURGERY INSTITUTE OF WI LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $2830.00 | 1881662856 - SILICON VALLEY SURGERY CENTER, LP | 770495522 - (CA) SILICON VALLEY SURGERY CENTER, L.P. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $200.00 | 1528553559 - SURGICAL PAIN CENTER OF THE ADIRONDACKS, LLC | 821943675 - (NY) SURGICAL PAIN CENTER OF THE ADIRONDACKS LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $105.00 | 1295086049 - WOMENS CENTER FOR ADVANCED SURGERY INC | 454798001 - (GA) WOMENS CENTER FOR ADVANCED SURGERY INC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $322.00 | 1790822864 - NORTHWEST EYE SPECIALISTS,LLC | 860720868 - (AZ) NORTHWEST EYE SPECIALISTS, P.L.L.C. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $120.00 | 1184894693 - LA/OC SURGICAL CENTER, INC. | 262108942 - (CA) LAOC SURGICAL CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $170.00 | 1285692004 - TEC NORTH, LLC, THE ENDOSCOPY CENTER NORTH | 201871076 - (TN) TEC NORTH LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $200.00 | 1316342579 - ENCINO SURGICAL CENTER LLC | 471132992 - (CA) ENCINO SURGICAL CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $230.00 | 1801825880 - SURGERY CENTER AT RIVER ROAD, LLC, AESTHETIC SURGERY AT HACIENDA DEL SOL | 760824670 - (AZ) SURGERY CENTER AT RIVER ROAD, LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $325.00 | 1508040486 - PORTLAND CLINIC, ROGER E. ALBERTY, M.D. SURGICAL CENTER | 930400952 - (OR) THE PORTLAND CLINIC LLP | OR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $506.00 | 1598083594 - MID-STATE ENDOSCOPY CENTER LLC | 270673692 - (TN) MIDSTATE ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $1215.00 | 1255353389 - SOMERSET AMBULATORY SURGICAL CENTER, LLC | 371743209 | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $927.00 | 1508851213 - FROEDTERT SURGERY CENTER, LLC | 201499345 - (WI) FROEDTERT SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22116 | $100.00 | 1740228790 - CAPITAL SURGERY CENTER LLC | 522325983 - (MD) CAPITAL SURGERY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 22116 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22116 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 22116 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 22110-CPT | High | Partial Excision Of Vertebral Body, For Intrinsic Bony Lesion, Without Decompression Of Spinal Cord Or Nerve Root(S), Single Vertebral Segment; Cervical |
| 22112-CPT | High | Partial Excision Of Vertebral Body, For Intrinsic Bony Lesion, Without Decompression Of Spinal Cord Or Nerve Root(S), Single Vertebral Segment; Thoracic |
| 22114-CPT | High | Partial Excision Of Vertebral Body, For Intrinsic Bony Lesion, Without Decompression Of Spinal Cord Or Nerve Root(S), Single Vertebral Segment; Lumbar |
| 22116-CPT | Low | Partial Excision Of Vertebral Body, For Intrinsic Bony Lesion, Without Decompression Of Spinal Cord Or Nerve Root(S), Single Vertebral Segment; Each Additional Vertebral Segment (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22116 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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