CPT 22868 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-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 • 59 - Distinct Procedural Service • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 22868 |
National average reimbursement for CPT 22868 by major payers:
$309.05
$341.69
$335.03
$410.05
| 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 22868 | ||||||
United | 22868 | $116.00 | 1922335900 - PALMETTO LAKES SURGICAL CENTER, LLC | 943459481 - (FL) PALMETTO LAKES SURGICAL CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $566.00 | 1346383155 - BRIARCLIFF AMBULATORY SURGERY CENTER LP, BRIARCLIFF SURGERY CENTER | 202852584 - (MO) BRIARCLIFF AMBULATORY SURGERY CENTER LP | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $506.00 | 1750499950 - MEDPLEX OUTPATIENT SURGERY CENTER LTD, MEDPLEX OUTPATIENT SURGERY CENTER | 760353620 - (AL) MEDPLEX OUTPATIENT SURGERY CENTER LTD | AL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $530.00 | 1710688627 - BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | 922359229 - (KY) BAPTIST HEALTH SURGERY CENTER BRECKENRIDGE LLC | KY | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $537.00 | 1396896684 - DREYER AMBULATORY SURGERY CENTER, LLC | 363890298 - (IL) DREYER AMBULATORY SURGERY CENTER LLC | IL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $633.00 | 1871032680 - OLIVE AMBULATORY SURGERY CENTER, LLC, NORTH CAMPUS SURGERY CENTER | 203834012 - (MO) OLIVE AMBULATORY SURGERY CENTER LLC | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $94.00 | 1720048242 - MARYLAND SURGERY CENTER FOR WOMEN LLC, MARYLAND SURGERY CENTER | 522215638 - (MD) MARYLAND SURGERY CENTER FOR WOMEN, LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $500.00 | 1750386256 - PALOUSE SURGERY CENTER, LLC | 810593962 - (ID) PALOUSE SURGERY CENTER LLC | ID | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $1005.00 | 1659793891 - INOVA AMBULATORY SURGERY CENTER AT LORTON, LLC | 461955980 - (VA) INOVA AMBULATORY SURGERY CENTER AT LORTON LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $612.00 | 1659953636 - VCU HEALTH AMBULATORY SURGERY CENTER, LLC | 863310585 - (VA) VCU HEALTH AMBULATORY SURGERY CENTER LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $688.00 | 1205195716 - ADVANCED ENDOSCOPY AND PAIN CENTER LLC | 454651695 - (CA) ADVANCED ENDOSCOPY AND PAIN CENTER LLC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $316.00 | 1356488837 - RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC | 204239587 - (KS) RIDGEWOOD SURGERY AND ENDOSCOPY CENTER, LLC | KS | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $424.00 | 1669705034 - EYE SPECIALISTS SURGERY CENTERS, LLC, MUNCIE SURGICAL CARE CENTER | 270927202 | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $688.00 | 1629559208 - ORTHOARIZONA SURGERY CENTER GILBERT, LLC, ORTHOARIZONA SURGERY CENTER GILBERT | 823624585 - (AZ) ORTHOARIZONA SURGERY CENTER GILBERT LLC | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22868 | $391.00 | 1457968430 - PARK VENTURA ENDOSCOPY CENTER, LLC, DIGESTIVE HEALTH CENTER OF ALLEN | 412059014 - (TX) PARK VENTURA ENDOSCOPY CENTER LLC | TX | 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 22868 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22868 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 22868 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 |
|---|---|---|
| 22632-CPT | Moderate | Arthrodesis, Posterior Interbody Technique, Including Laminectomy And/Or Discectomy To Prepare Interspace (Other Than For Decompression), Single Interspace; Each Additional Interspace (List Separately In Addition To Code For Primary Procedure) |
| 22634-CPT | Moderate | Arthodesis Combined Posterior Or Posterolateral Technique With Posterior Interbody Technique Including Laminectomy And/Or Discectomy Suffcient To Prepare Interspace (Other Than For Decom- Pression) Single Interspace; Each Additional Interspace And Segment (List Separately In Addition To Code For Primary Procedure) (Desc Rvsd 1/1/22) |
| 22867-CPT | High | Insertion Of Interlaminar/Interspinous Process Stabilization/Distraction Device Without Fusion Including Imaging Guidance When Per- Formed With Open Decompression Lumbar; Single Level |
| 22868-CPT | Moderate | Insertion Of Interlaminar/Interspinous Process Stabilization/Distraction Device Without Fusion Including Imaging Guidance When Performed With Open Decompression Lumbar Second Level (List Separately In Addition To Code For Primary Pro- Cedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22868. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22868 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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