CPT 22222 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | • 11 - Office • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GO - Services delivered under an outpatient occupational therapy plan of care |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22222 |
National average reimbursement for CPT 22222 by major payers:
$2,025.79
$2,205.86
$2,343.86
$2,766.14
| 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 22222 | ||||||
United | 22222 | $4642.00 | 1235715996 - CENTRAL UTAH SURGICENTER, LLC | 862348485 - (UT) CENTRAL UTAH SURGICENTER LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $2215.00 | 1386652667 - MACON OUTPATIENT SURGERY, LLC | 203027560 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $1040.00 | 1326215468 - ST CLAIR SHORES MI OPHTHALMOLOGY ASC LLC | 261470972 - (MI) ST CLAIR SHORES MI OPHTHALMOLOGY ASC LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $4394.00 | 1629713730 - PG COUNTY ENDOSCOPY CENTER LLC | 881766792 - (MD) PG COUNTY ENDOSCOPY CENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $1900.00 | 1669437109 - MARIETTA OUTPATIENT SURGERY, LTD | 752160466 - (GA) MARIETTA OUTPATIENT SURGERY LTD | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $1020.00 | 1619166097 - GPDDC, LLC | 43769350 - (NY) GPDDC, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $14053.00 | 1902052350 - SURGERY CENTER, LLC | 263169180 - (WI) THE SURGERY CENTER, LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $5963.00 | 1144333881 - NORTH SCOTTSDALE AMBULATORY SURGERY CENTER, LLC | 200554616 - (AZ) NORTH SCOTTSDALE AMBULATORY SURGERY CENTER LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $4700.00 | 1073113841 - SPINE SOLUTIONS OF WEST BEND LLC | 853661644 - (WI) SPINE SOLUTIONS OF WEST BEND LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $900.00 | 1598189342 - MEI SURGERY CENTER LLC, MICHIGAN EYE SURGERY CENTER | 461591012 - (MI) MEI SURGERY CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $4704.00 | 1760912554 - BAYLOR SURGICARE AT BAYLOR PLANO, LLC, BAYLOR SCOTT & WHITE SURGICARE AT PLANO ALLIANCE | 813127185 - (TX) BAYLOR SURGICARE AT BAYLOR PLANO LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $4809.00 | 1366154304 - OPTUM CARE WASHINGTON PLLC, OPTUM - HELEN HOLM PUMPHREY SURGERY CENTER | 910214500 - THE EVERETT CLINIC, PLLC | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $747.00 | 1902431646 - CENTRAL OHIO ENDOSCOPY CENTER, LLC | 311674561 - (OH) CENTRAL OHIO ENDOSCOPY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $4244.00 | 1629008677 - OPEN ACCESS VASCULAR ACCESS CENTER, INC | 650973601 - (FL) OPEN ACCESS VASCULAR ACCESS CE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22222 | $3145.00 | 1790197606 - UROLOGY HEALTH SURGERY CENTER, LLC | 260412126 - (PA) UROLOGY HEALTH SURGERY CENTER LLC | PA | 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 22222 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22222 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 22222 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 |
|---|---|---|
| 22220-CPT | High | Spine Osteotomy,Anterior,Corr.Deform,1 S |
| 22222-CPT | High | Osteotomy Spine Ant Appr-Thoracic |
| 22224-CPT | High | Spine Osteotomy,Anterior,Corr.Deform,1 S |
| 22226-CPT | Moderate | Osteotomy Of Spine, Including Discectomy, Anterior Approach, 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 22222. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22222 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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