CPT 22855 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22855 |
National average reimbursement for CPT 22855 by major payers:
$1,327.67
$1,499.67
$1,593.11
$1,837.77
| 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 22855 | ||||||
United | 22855 | $1275.00 | 1356814958 - CLEVELAND CHILDRENS SURGERY CENTER LLC | 301128634 - (OH) CLEVELAND CHILDRENS SURGERY CENTER LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $2759.00 | 1144497264 - CALIFORNIA SKIN SURGERY CENTER INC | 262564861 - (CA) CALIFORNIA SKIN SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $9347.00 | 1215930078 - MARIN HEALTH VENTURES, LLC, MARIN SPECIALTY SURGERY CENTER | 943377073 - (CA) MARIN HEALTH VENTURES, INC. DBA MARIN SPECIALTY SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $1861.00 | 1922262278 - EPS SURGICAL CENTER, LLC | 260875908 - (GA) EPS SURGICAL CENTER LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $3000.00 | 1003553645 - CYPRESS AMBULATORY SURGERY CENTER, LLC, CURRENCY CIRCLE SURGERY CENTER | 823481913 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $3900.00 | 1316603699 - HEATHROW SURGERY CENTER LLC | 851780627 - (FL) HEATHROW SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $1503.00 | 1487779435 - LAKEFOREST AMBULATORY SURGERY CENTER, DISTRICT HEIGHTS AMBULATORY SURGERY CENTER | 521944179 - (MD) LAKEFOREST AMBULATORY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $4988.00 | 1083653554 - UROLOGY SURGICAL PARTNERS, LLC | 582622573 - (GA) UROLOGY SURGICAL PARTNERS, LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $7229.00 | 1346383155 - BRIARCLIFF AMBULATORY SURGERY CENTER LP, BRIARCLIFF SURGERY CENTER | 202852584 - (MO) BRIARCLIFF AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $3713.00 | 1538664339 - FOLSOM ENDOSCOPY CENTER LLC, FOLSOM SIERRA ENDOSCOPY CENTER | 824882599 - (CA) FOLSOM ENDOSCOPY CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $1806.00 | 1376518357 - ORLANDO FL ENDOSCOPY ASC LLC, CITRUS AMBULATORY SURGERY CENTER | 202873015 - ORLANDO FL ENDOSCOPY ASC LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $5500.00 | 1780691386 - ORTHOPAEDIC SPECIALISTS SURGI-CENTER, LLC | 201407302 - (DE) ORTHOPAEDIC SPECIALISTS SURGICENTER LLC | DE | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $3843.00 | 1376607309 - EMERALD SURGICAL CENTER LLC | 820485376 - (ID) EMERALD SURGICAL CENTER, L.L.C. | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $6365.00 | 1124125604 - MURDOCK AMBULATORY SURGERY CENTER LLC | 201543128 - (FL) MURDOCK AMBULATORY SURGERY CENTE | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22855 | $1222.00 | 1114912102 - BOISE ENDOSCOPY CENTER, LLC | 820506078 - (ID) BOISE ENDOSCOPY CENTER LLC | ID | 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 22855 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22855 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 22855 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 |
|---|---|---|
| 22850-CPT | Moderate | Remv Nonseg.Instrument-Harrngtn Rod |
| 22852-CPT | Moderate | Removal Post Segmental Instrument |
| 22853-CPT | Moderate | Insertion Of Interbody Biomechanical Device(S) (Egsynthetic Cage Mesh) With Integral Anterior With Integral Anterior Instrumentation For Device An- Choring (Eg Screws Flanges) When Performed To Intervertebral Disc Space In Conjunction With In- Terbody Arthrodesis Each Interspace (List Separately In Addition To Code For Primary Pro- Cedure |
| 22855-CPT | High | Removal Of Anterior Instrumentation |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22855. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22855 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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