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 |
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 | $200.00 | 1750892659 - NOVANT HEALTH KERNERSVILLE OUTPATIENT SURGERY LLC | 821651821 - (NC) NOVANT HEALTH KERNERSVILLE OUTPATIENT SURGERY LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $218.00 | 1063641801 - PRESBYTERIAN SAMEDAY SURGERY CENTER AT HUNTERSVILLE LLC, NOVANT HEALTH HUNTERSVILLE OUTPATIENT SURGERY | 262422926 - (NC) PRESBYTERIAN SAMEDAY SURGERY CENTER AT HUNTERSVILLE LLC | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $146.00 | 1922079896 - SOUTHERN OKLA SURGICAL SERVICES, ARDMORE REGIONAL SURGERY CENTER | 262814211 - (OK) ARDMORE REGIONAL SURGERY CENTER | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $472.00 | 1972541415 - OCEAN ENDOSURGERY CENTER LLC, OCEAN ENDOSURGERY CENTER | 223564617 - (NJ) OCEAN ENDOSURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $345.00 | 1922211192 - VOORHEES SURGERY CENTER, LLC | 651203770 - (NJ) VOORHEES SURGERY CENTER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $45.00 | 1457502239 - APOLLO SURGERY CENTER LLC | 261387775 - (FL) APOLLO SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $88.00 | 1073621512 - DIGESTIVE DISEASE CENTER | 880291959 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $1735.00 | 1538179551 - HENRY FORD MEDICAL CENTER FAIRLANE, HENRY FORD HEALTH SYSTEM | 381357020 - HENRY FORD HEALTH SYSTEM | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $531.00 | 1750565594 - PEDIATRIC SURGERY CENTER -ODESSA, LLC | 651274446 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $150.00 | 1619037066 - THE EL DORADO AR MULTISPECIALTY ASC LLC, SOUTH ARKANSAS SURGERY CENTER | 203954951 - (AR) THE EL DORADO AR MULTISPECIALTY ASC LLC | AR | 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 | 22854 | $188.00 | 1689326670 - PRISMA HEALTH AMBULATORY SURGERY CENTERS-MIDLANDS, LLC, PRISMA HEALTH ORTHOPEDIC SURGERY CENTER | 873101776 - (SC) PRISMA HEALTH AMBULATORY SURGERY CENTERSMIDLANDS LLC | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $345.00 | 1922237213 - ENDOSCOPY CENTER OF TOMS RIVER, LLC | 300568338 - (NJ) ENDOSCOPY CENTER OF TOMS RIVER LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $88.00 | 1942318498 - DIGESTIVE DISEASE CENTER | 880291959 | NV | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22854 | $1886.00 | 1184752305 - SEASHORE SURGICAL INSTITUTE, LLC | 223660141 - (NJ) SEASHORE SURGICAL INSTITUTE | 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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