CPT 22864 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 22864 |
National average reimbursement for CPT 22864 by major payers:
$2,535.79
$2,726.60
$2,904.63
$3,352.50
| 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 22864 | ||||||
United | 22864 | $4393.00 | 1174679054 - CROSSROADS SURGERY CENTER, LLC | 562622609 - (TN) CROSSROADS SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $3330.00 | 1184690570 - PAIN CARE SURGERY, PC | 371379699 - (IL) PAIN CARE SURGERY PC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $1390.00 | 1730382789 - ENDOSCOPY CENTER | 260317060 - (NC) ENDOSCOPY CENTER | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $6492.00 | 1427152073 - PATIENT PARTNERS LLC | 201400198 - (TN) PATIENT PARTNERS LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $7655.00 | 1588681373 - CONSTITUTION SURGERY CENTER EAST LLC | 61574704 - (CT) CONSTITUTION EYE SURGERY CENTER EAST, LLC | CT | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $3275.00 | 1871924027 - PRESTON SURGERY CENTER, LLC | 462415142 - (TX) PRESTON SURGERY CENTER LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $5300.00 | 1821036534 - PARKWAY SURGERY CENTER, LLC | 204127100 - (MD) PARKWAY SURGERY CENTER | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $425.00 | 1376538876 - THE ENDOSCOPY CENTER OF BRISTOL | 621727371 - (TN) THE ENDOSCOPY CENTER OF BRISTOL | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $3182.00 | 1396719563 - BAPTIST GERMANTOWN SURGERY CENTER, LLC, BAPTIST GERMANTOWN SURGERY CENTER | 621829424 - (TN) BAPTIST GERMANTOWN SURGERY CENTER LLC | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $4677.00 | 1437155207 - TEXARKANA SURGERY CENTER LP | 752807190 - (TX) TEXARKANA SURGERY CENTER LP | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $7888.00 | 1366406233 - MIDDLE TENNESSEE AMBULATORY SURGERY CENTER, L.P. | 621699667 - (TN) MIDDLE TENNESSEE AMBULATORY SURGERY CENTER LP | TN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $3090.00 | 1841347143 - RUXTON SURGICENTER LLC | 522095835 - (MD) RUXTON SURGICENTER LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $6365.00 | 1891148219 - SUMMIT AMBULATORY SURGICAL CENTER, LLC | 522148280 | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $949.00 | 1902838402 - OUTPATIENT SURGERY CENTER, INC, MARINER SURGERY CENTER | 30504664 - (FL) OUTPATIENT SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22864 | $4800.00 | 1033560420 - ABINGDON SURGICAL CENTER PC | 813054896 - (MD) ABINGDON SURGICAL CENTER PC | MD | 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 22864 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22864 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 22864 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) |
| 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22864. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22864 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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