CPT 22861 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 • 24 - Ambulatory Surgical Center |
| Common Modifiers | • None • AS - PA/NP/CNS assistant at surgery • 78 - Return to OR - related procedure • 59 - Distinct Procedural Service |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 22861 |
National average reimbursement for CPT 22861 by major payers:
$2,832.17
$2,980.53
$3,118.60
$3,675.02
| 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 22861 | ||||||
United | 22861 | $13000.00 | 1497105803 - GEORGIA INTERVENTIONAL PAIN | 812947115 - (GA) GEORGIA INTERVENTIONAL PAIN | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $11558.00 | 1205361052 - MINIMALLY INVASIVE SURGERY CENTER OF N.E., LLC | 815005653 | NH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $4235.00 | 1043473390 - LAKEWOOD EYE PHYSICIANS AND SURGEONS INC A MEDICAL GROUP | 952858745 - (CA) LAKEWOOD EYE PHYSICIANS & SURGEONS, INC. | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $2205.00 | 1043246077 - DUTCHESS AMBULATORY SURGICAL CENTER | 141803011 - (NY) DUTCHESS AMBULATORY SURGICAL CENTER | NY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $14000.00 | 1639135346 - SURGERY CENTERS OF DES MOINES LTD | 363562598 | IA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $3530.00 | 1164734232 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE, LLC | 272910652 - MIDSOUTH INTERVENTIONAL PAIN INSTITUTE LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $11424.00 | 1922160357 - ARAPAHOE ENDOSCOPY CENTER PARTNERSHIP PLLP | 472388780 | CO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $1050.00 | 1104829597 - HOGAN SURGICAL CENTER, P. A. | 300399671 - (MS) HOGAN SURGICAL CENTER P A | MS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $10594.00 | 1972845923 - OLIVE AMBULATORY SURGERY CENTER, LLC, EMERSON ROAD SURGERY CENTER | 203834012 - (MO) OLIVE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $14000.00 | 1336445873 - SAND LAKE SURGICENTER LLC, SAND LAKE SURGERY CENTER | 273787593 - (FL) SAND LAKE SURGICENTER, LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $3696.00 | 1184627978 - NOVAMED SURGERY CENTER OF ORLANDO LLC, DOWNTOWN SURGERY CENTER | 522441418 - (FL) NOVAMED SURGERY CENTER OF ORLANDO LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $9510.00 | 1659772648 - SURGICAL SPECIALTY CENTER OF MID ATLANTIC, LLC | 465727021 - (MD) SURGICAL SPECIALTY CENTER OF MID-ATLANTIC, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $10000.00 | 1851467740 - WIREGRASS RANCH ASC HOLDINGS, WIREGRASS RANCH SPECIAL PROCEDURES CENTER | 991010158 - (FL) WIREGRASS RANCH ASC HOLDINGS | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $8917.00 | 1043803877 - PALM BEACH INTERNATIONAL SURGERY CENTER LLC, PALM BEACH INTERNATIONAL SURGERY CENTER AT THE PALEY INSTITUTE | 384092545 - (FL) PALM BEACH INTERNATIONAL SURGERY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22861 | $1345.00 | 1043290653 - SUNCOAST SURGERY CENTER, LLC | 650913259 | FL | 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 22861 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22861 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 22861 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 |
| 22861-CPT | High | 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 | High | Once Per Dos Revision Including Replacement Of Total Disc Arthroplasty, Anterior Approach, Single Interspace; Lumbar - Deny Inv/N10 Except Uhs <12/31/2020 |
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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