CPT 22511 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 | • 22 - On Campus Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22511 |
National average reimbursement for CPT 22511 by major payers:
$1,964.26
$2,393.79
$2,534.29
$2,864.25
| 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 22511 | ||||||
United | 22511 | $1172.00 | 1154555472 - GEORGIA RETINA SURGERY CENTER, LLC | 262303683 - (GA) GEORGIA RETINA SURGERY CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $2350.00 | 1497105803 - GEORGIA INTERVENTIONAL PAIN | 812947115 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $5050.00 | 1679544050 - TUSCALOOSA SURGICAL CENTER LP, TUSCALOOSA SUR | 630974161 - (AL) TUSCALOOSA SURGICAL CENTER LP | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $2100.00 | 1225523970 - BURNSVILLE SURGERY CENTER, P.A. | 830965169 - (MN) BURNSVILLE SURGERY CENTER PA | MN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $2183.00 | 1285213009 - UM SHORE REGIONAL HEALTH SURGERY CENTER AT CAMBRIDGE, LLC, UM SHORE REGIONAL HEALTH SURGERY CENTER AT CAMBRIDGE | 372002744 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $3623.00 | 1477615284 - ROCKY MOUNTAIN ENDOSCOPY CENTERS, LLC | 841403147 - (CO) ROCKY MOUNTAIN ENDOSCOPY CENTERS LLC | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $1944.00 | 1346237237 - LUFKIN ENDOSCOPY CENTER LTD | 204411582 - (TX) LUFKIN ENDOSCOPY CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $2700.00 | 1558792598 - PARIS SURGERY CENTER, LLC | 461871794 - (TX) PARIS SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $1385.00 | 1235706888 - SOUTHERN SURGICAL CENTER, LLC | 844035828 - (LA) SOUTHERN SURGICAL CENTER LLC | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $4556.00 | 1598772634 - UTAH SURGERY CENTER LP | 562601697 - (UT) UTAH SURGERY CENTER LP | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $1100.00 | 1457813107 - SURGEON'S SURGERY CENTER SORELLE PLLC | 831414422 - (NV) SURGEONS SURGERY CENTER SORELLE PLLC | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $5000.00 | 1104301613 - LOGAN SURGICAL SUITES LLC, ADVANCED SURGERY CENTER OF NORTHERN UTAH | 822435405 - (UT) LOGAN SURGICAL SUITES LLC | UT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $1300.00 | 1538242649 - SOUTHWESTERN ENDOSCOPY CENTER, LLC | 571139709 - (PA) SOUTHWESTERN ENDOSCOPY CENTER, LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $3500.00 | 1053721530 - WISCONSIN SPECIALTY SURGERY CENTER,LLC | 464559699 - (WI) WISCONSIN SPECIALTY SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22511 | $7186.00 | 1275596264 - CAROLINA REGIONAL SURGERY CENTER. LTD | 621616402 - (SC) CAROLINA REGIONAL SURGERY CENTER LTD | SC | 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 22511 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22511 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 22511 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 |
|---|---|---|
| 22510-CPT | High | Percutaneous Vertebral Augmentation Including Imaging Guidance If Applicable; 1 Vertebral Body. Unilateral Or Bilateral Injection Including Imaging Guidance- Cervicothoracic |
| 22511-CPT | High | Percutaneous Vertebral Augmentation Including Imaging Guidance If Applicable; 1 Vertebral Body. Unilateral Or Bilateral Injection Including Imaging Guidance- Lumbosacral |
| 22512-CPT | Moderate | Percutaneous Vertebroplasty (Bone Biopsy Included When Performed), 1 Vertebral Body, Unilateral Or Bilateral Injection, Inclusive Of All Imaging Guidance; Each Additional Cervicothoracic Or Lumbosacral Vertebral Body (List Separately In Addition To Code For Primary |
| 22513-CPT | High | Percutaneous Vertebral Augmentation Including Cavity Creation (Fracture Reduction And Bone Biopsy Included When Performed) Using Mechanical Device (Eg Kyphoplasty) 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance; Thoracic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22511. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22511 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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