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See a sample rate comparisonCPT 22861 Fee Schedule
Medicare rates as of October 2026
CPT 22861 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Once Per Dos Revision Including Replacement Of Total Disc Arthroplasty, Anterior Approach, Single-Medicaid:Rn Review>9/15/2015.Commercial Rn Review=9/15/2015-3/31/2022
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 21Inpatient Hospital 24Ambulatory Surgical Center |
| Common Modifiers | ASPA/NP/CNS assistant at surgery 78Return to OR - related procedure 59Distinct Procedural Service |
| Hospital Outpatient Group (APC) | APC 5116 - Level 6 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Add-on Codes | 0098T |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | $2,248.88 national non-facility rate (2026)View Medicare rates for 22861 |
| Medicaid Fee Schedule | $1,699.36 median of the 8 states in the free previewView Medicaid rates for 22861 |
National average reimbursement for CPT 22861 by major payers:
$2,832.17
BCBS / Anthem
$2,980.53
UnitedHealthcare
$3,118.60
Aetna
$3,675.02
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 22861.
CPT 22861
5 of 25 sample ratesHigher to lower in this preview
Surgery Centers Of Des Moines Ltd
$14,000.00Published rateArapahoe Endoscopy Center Partnership Pllp
$11,424.00Published ratePalm Beach International Surgery Center LLC, Palm Beach International Surgery Center At The Paley Institute
Palm Beach International Surgery Center LLC
$8,917.00Published rateLeo R. Mccafferty, M.D., Surgical Center
$3,920.00Published rateHogan Surgical Center, P. A.
Hogan Surgical Center P A
$1,050.00Published rate
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See a sample payer proposalCPT 22861 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 22861. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 22861-CPT | Once Per Dos Revision Including Replacement Of Total Disc Arthroplasty, Anterior Approach, Single-Medicaid:Rn Review>9/15/2015.Commercial Rn Review=9/15/2015-3/31/2022 |
| 22862-CPT | Once Per Dos Revision Including Replacement Of Total Disc Arthroplasty, Anterior Approach, Single Interspace; Lumbar - Deny Inv/N10 Except Uhs <12/31/2020 |
| 22864-CPT | Once Per Dos Removal Of Total Disc Arthroplasty, Anterior Approach, Single Interspace; Cervical-Medicaid:Rn Review>9/15/2015.Commercial Rn Review=9/15/2015-3/31/2022 |
| 22865-CPT | Remval Of Total Disc Arthroplst (Artifici Disc) Anterio Approac, Removal Of Total Disc Arthroplasty (Artificial Disc) Anterior Approac |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22861. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22861 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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Frequently Asked Questions
What APC is CPT 22861 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 22861 to APC 5116 (Level 6 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 22861 in an ambulatory surgery center?
CMS lists CPT 22861 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which add-on codes are billed with CPT 22861?
CMS add-on code edits list CPT 22861 as a primary code for these add-on codes: 0098T.
Which revenue codes are billed with CPT 22861?
Hospital price transparency files list CPT 22861 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.