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See a sample rate comparisonCPT 22861 Fee Schedule
Last Verified: September 2026
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.
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 | 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 |
| Medicaid Fee Schedule | View Medicaid rates for 22861 |
National average reimbursement for CPT 22861 by major payers:
$2,832.17
$2,980.53
$3,118.60
$3,675.02
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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 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 |
|---|---|---|
| 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 |
| 22864-CPT | High | 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 | High | 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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