CPT 22856 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • SG - Scene to Hospital ESRD facility |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22856 |
National average reimbursement for CPT 22856 by major payers:
$2,101.22
$2,237.94
$2,379.34
$2,737.65
| 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 22856 | ||||||
United | 22856 | $3003.00 | 1467979443 - MVH ENDOSCOPY LLC, PCS ENDOSCOPY SUITE | 822606374 - (ID) MVH ENDOSCOPY LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $2704.00 | 1275516718 - PREMIER SURGICAL CENTER, INC | 200671644 - (ID) PREMIER SURGICAL CENTER INC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $5200.00 | 1851848253 - PINNACLE SURGERY CENTER OF AUSTIN | 813117589 - (TX) PINNACLE SURGERY CENTER OF AUSTIN LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $2994.00 | 1073546875 - STRAND GASTROINTESTINAL ENDOSCOPY CENTER | 571082826 - (SC) STRAND GASTROINTESTINAL ENDOSCOPY CENTER | SC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $4500.00 | 1043426950 - HOSPITAL DRIVE SURGERY CENTER, LLC | 770516196 - (CA) HOSPITAL DRIVE SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $28706.00 | 1255936761 - CROWN POINT SURGICAL SUITES, LLC | 851476511 - (IN) CROWN POINT SURGICAL SUITES LLC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $5500.00 | 1730410697 - SURGICAL SPECIALISTS AT PRINCETON LLC | 270749140 - (NJ) SURGICAL SPECIALISTS AT PRINCE | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $2868.00 | 1720509722 - CLEVELAND EAST VASCULAR CARE, LLC | 461853653 - (OH) CLEVELAND EAST VASCULAR CARE LLC | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $1956.00 | 1295766202 - MCGEE EYE SURGERY CENTER LLC | 621600425 - (OK) MCGEE EYE SURGERY CENTER LLC | OK | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $6365.00 | 1912434697 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $12000.00 | 1164584066 - NAPERVILLE SURGICAL CENTRE LLC | 200433367 - (IL) NAPERVILLE SURGICAL CENTRE, LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $6365.00 | 1326142878 - LEBANON ENDOSCOPY CENTER LLC, LEBANON ENDOSCOPY CENTER | 205449574 - (TN) LEBANON ENDOSCOPY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $4189.00 | 1457784852 - SMART PAIN SURGERY CENTER AT OWINGS MILLS, LLC, CLEARWAY SURGERY CENTER OF OWINGS MILLS | 454995677 - (MD) SMART PAIN SURGERY CENTER AT OWINGS MILLS LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $6124.00 | 1164732426 - NORWALK SURGERY CENTER, LLC | 272394942 - (CT) NORWALK SURGERY CENTER LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22856 | $6492.00 | 1346383155 - BRIARCLIFF AMBULATORY SURGERY CENTER LP, BRIARCLIFF SURGERY CENTER | 202852584 - (MO) BRIARCLIFF AMBULATORY SURGERY CENTER LP | MO | 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 22856 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22856 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 22856 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 |
|---|---|---|
| 22852-CPT | Moderate | Removal Post Segmental Instrument |
| 22855-CPT | High | Removal Of Anterior Instrumentation |
| 22856-CPT | High | Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy With End Plate Preparation (Includes Osteophytectomy For Nerve Root Or Spinal Cord Decompression And Microdissection) Single Interspace Cervical (Desc Revised 01/01/15) |
| 22858-CPT | Moderate | Total Disc Arthroplasty (Artificial Disc) Anterior Approach Including Discectomy With End Plate Preparation (Includes Osteophytectomy For Nerve Root Or Spinal Cord Decompression And Microdissection); Second Level Cervical (List Separately 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 22856. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22856 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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