CPT 22854 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 • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 22854 |
National average reimbursement for CPT 22854 by major payers:
$437.34
$471.62
$527.66
$563.75
| 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 22854 | ||||||
United | 22854 | $178.00 | 1518004696 - CENTURY CITY ENDOSCOPY, LLC | 954754975 - (CA) CENTURY CITY ENDOSCOPY LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $566.00 | 1184680225 - CAPITAL CITY SURGICAL CENTER LLC, CAPITAL CITY SURGICAL CENTER LLC | 471211202 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $355.00 | 1063408649 - AIMS OUTPATIENT SURGERY | 860751146 - (AZ) AIMS OUTPATIENT SURGERY | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $688.00 | 1932735677 - PARKCREEK ASC LLC | 843082809 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $10491.00 | 1417912098 - BAILEY SQUARE AMBULATORY SURGICAL CENTER, LTD | 752467365 - (TX) BAILEY SQUARE AMBULATORY SURGICAL CENTER LTD | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $1301.00 | 1013227248 - TUSCAN SURGERY CENTER AT LAS COLINAS, LLC, TUSCAN SURGERY CENTER AT LAS COLINAS | 273578014 | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $475.00 | 1104880723 - WNC EYE SURGERY CENTERS INC | 200067898 - (NC) WNC EYE SURGERY CENTERS INC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $327.00 | 1184749673 - WAYNE SURGICAL CENTER LLC | 223535325 - (NJ) WAYNE SURGICAL CENTER, LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $328.00 | 1083796221 - SOUTHERN INDIANA SURGERY CENTER, LLC, SOUTHERN INDIANA SURGERY CENTER | 351829838 - (IN) SOUTHERN INDIANA SURGERY CENTER | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $235.00 | 1255875126 - VIP SURG ASC, LLC, VIP SURGICAL CENTER | 811621842 - (TX) VIP SURG ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $77.00 | 1780664185 - HILLMONT ASC LP, SPRINGFIELD AMBULATORY SURGERY CENTER | 621641866 | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $706.00 | 1316949415 - NEWPORT BEACH SURGERY CENTER, LLC, NEWPORT BEACH SURGERY CENTER | 330488134 - (CA) NEWPORT BEACH SURGERY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $569.16 | 1881129286 - JOEL PHELPS | 350593390 - DEACONESS HOSPITAL INC | IN | Hospitalist Physician (208M00000X) |
United | 22854 | $88.00 | 1942318498 - DIGESTIVE DISEASE CENTER | 880291959 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $250.00 | 1659377042 - TOMS RIVER AMBULATORY SURGICAL CENTER, BEY LEA AMBULATORY SURGICAL CENTER | 223802381 - (NJ) TOMS RIVER AMBULATORY SURGICAL CENTER | NJ | 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 22854 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22854 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 22854 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 |
|---|---|---|
| 22849-CPT | High | Reinsert Spinal Fixation Device |
| 22850-CPT | Moderate | Remv Nonseg.Instrument-Harrngtn Rod |
| 22852-CPT | Moderate | Removal Post Segmental Instrument |
| 22854-CPT | Moderate | Insertion Of Intervertebral Biomechanical De Vice(S) Eg Synthetic Cage Mesh) With Integral Anterior Instrumentation For Device Anchoring (Eg Screws Flanges) When Performed To Verte- Bral Corpectomy(Ies) (Vertebral Body Resection Partial Or Complete) Defect In Conjunction With Interbody Arthrodesis Each Contiguous Defect (List Eparately 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 22854. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22854 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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