CPT 22315 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 | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 51 - Multiple procedures • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22315 |
National average reimbursement for CPT 22315 by major payers:
$1,110.52
$1,163.45
$1,256.11
$1,467.41
| 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 22315 | ||||||
United | 22315 | $600.00 | 1710290606 - GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER, GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER | 271921975 - (GA) GEORGIA NEUROSURGICAL INSTITUTE OUTPATIENT SURGERY CENTER | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $500.00 | 1306438007 - COMPREHENSIVE SURGICAL CARE OF GILBERT, LLC | 852825570 - (AZ) COMPREHENSIVE SURGICAL CARE OF GILBERT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1666.00 | 1891701611 - ESSEX ENDOSCOPY CENTER LLC | 223777761 - (NJ) ESSEX ENDOSCOPY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $611.00 | 1285202077 - SURGCENTER OF PINE RIDGE LLC | 853561528 - (FL) SURGCENTER OF PINE RIDGE LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $514.00 | 1659683662 - PREMIER ENDOSCOPY CENTER, LLC | 272932575 - (AZ) PREMIER ENDOSCOPY CENTER, P.L.L.C. | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $2701.00 | 1861825986 - VADNAIS HEIGHTS SURGERY CENTER LLC, VADNAIS HEIGHTS SURGERY CENTER | 371866891 | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1233.00 | 1275198673 - UROLOGY ASC- PHOENIX, LLC, UROLOGIC SURGERY CENTER OF ARIZONA | 320586987 | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1258.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $2355.00 | 1336288703 - VIRGINIA MASON MEDICAL CENTER, VIRGINIA MASON ISSAQUAH ASC | 910565539 - (WA) VIRGINIA MASON MEDICAL CENTER | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1300.00 | 1407305063 - GASTROENTEROLOGY OF WESTCHESTER, LLC, GASTROENTEROLOGY OF WESTCHESTER, LLC | 821095121 - (NY) GASTROENTEROLOGY OF WESTCHESTER LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $803.00 | 1073758298 - BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC, BAPTIST HEALTH ENDOSCOPY CENTER AT GALLOWAY NORTH | 201796841 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1327.00 | 1598039125 - ROOSEVELT SURGERY CENTER, LLC | 271778024 - (NY) ROOSEVELT SURGERY CENTER, LLC | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1276.00 | 1992713176 - DESERT RIDGE OUTPATIENT SURGERY LLC | 202528902 - (AZ) DESERT RIDGE OUTPATIENT SURGERY LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $630.00 | 1770581829 - PHYSICIANS' SURGERY CENTER, LLC | 481217506 - (KS) PHYSICIANS SURGERY CENTER, L.L.C. | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22315 | $1258.00 | 1548217128 - GULFSHORE ENDOSCOPY CENTER LLC | 650615196 - (FL) GULFSHORE ENDOSCOPY CENTER LLC | FL | 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 22315 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22315 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 22315 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 |
|---|---|---|
| 22310-CPT | Moderate | Treat Fx/Disloc-Vertebral Body |
| 22315-CPT | High | Closed Treatment Of Vertebral Fracture(S) And/Or Dislocation(S) Requiring Casting Or Bracing With And Including Casting And/Or Bracing With Or Without Anesthesia By Manipulation Or Traction |
| 22318-CPT | High | Open Treatment And/Or Reduction Of Odontoid Fracture(S) And Or Dislocation(S) (Including Os Odontoideum), Anterior Approach, Including Placement Of Internal Fixation; Without Grafting |
| 22319-CPT | High | Open Treatment And/Or Reduction Of Odontoid Fracture(S) And Or Dislocation(S) (Including Os Odontoideum), Anterior Approach, Including Placement Of Internal Fixation; With Grafting |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22315. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22315 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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