CPT 22869 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 | • 24 - Ambulatory Surgical Center • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • SG - Scene to Hospital ESRD facility • 74 - Discontinued After Anesthesia |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 22869 |
National average reimbursement for CPT 22869 by major payers:
$605.81
$680.59
$645.08
$818.40
| 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 22869 | ||||||
United | 22869 | $4234.00 | 1639146541 - CENTENNIAL ASC, LLC, BAYLOR SURGICARE AT CENTENNIAL | 352199232 - (TX) CENTENNIAL ASC LLC | TX | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $12000.00 | 1497942460 - ORTHOPAEDIC SURGERY CENTER OF ASHEVILLE, LP, OUTPATIENT SURGERY CENTER OF ASHEVILLE | 621843091 - (NC) ORTHOPAEDIC SURGERY CENTER OF ASHEVILLE LP | NC | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $830.00 | 1306260815 - SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC | 351938206 - (IN) SURGERY CENTER OF EYE SPECIALISTS OF INDIANA PC | IN | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $4000.00 | 1235692120 - LIBERTY CORNER SURGICAL CENTER AT MARLTON LLC | 833889870 - (NJ) LIBERTY CORNER SURGICAL CENTER AT MARLTON LLC | NJ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $2700.00 | 1245393602 - MARYAM RAHBAR, MD, INC., PACIFIC COAST SPINE INSTITUTE AND PAIN CENTER | 205511930 - (CA) MARYAM RAHBAR MD INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $1004.00 | 1184697930 - THE ALEXANDRIA OPHTHALMOLOGY ASC LLC, WALLACE LASER AND SURGERY CENTER | 752830937 | LA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $1890.00 | 1619213303 - RIVERSIDE ENDOSCOPY CENTER LLC | 461567697 - (FL) RIVERSIDE ENDOSCOPY CENTER LLC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $5851.00 | 1437105368 - PROLIANCE SURGEONS, INC., P.S., PROLIANCE SKAGIT NORTHWEST ORTHOPEDIC SURGERY CENTER | 911606533 - (WA) PROLIANCE SURGEONS, INC., P.S. | WA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $1957.00 | 1942553300 - COLUMBIA SURGICAL INSTITUTE, LLC | 454449408 - (MD) COLUMBIA SURGICAL INSTITUTE LLC | MD | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $1022.00 | 1801094669 - CLEVELAND EYE AND LASER SURGERY CENTER LLC | 205487161 - (OH) CLEVELAND EYE & LASER SURGERY CENTER | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $2526.00 | 1588603351 - PHYSICIAN'S DAY SURGERY CENTER | 710623198 | AR | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $1033.00 | 1245399757 - KUMAR SURGICAL CENTER LLC | 383530839 - (MI) KUMAR SURGICAL CENTER LLC | MI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $2922.00 | 1154986347 - CENTER FOR VISUAL SURGICAL EXCELLENCE, LLC | 820674025 - (VA) CENTER FOR VISUAL SURGICAL EXCELLENCE LLC | VA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $954.00 | 1942483433 - PREMIER PHYSICIANS CENTERS, INC | 341783789 - (OH) PREMIER PHYSICIANS CENTERS, INC. | OH | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 22869 | $6365.00 | 1487716650 - CARONDELET ST. MARY'S NORTHWEST, LLC, CARONDELET FOOTHILLS SURGERY CENTER | 201086556 - (AZ) CAMP LOWELL SURGERY CENTER | AZ | 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 22869 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The CPT 22869 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 22869 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 |
|---|---|---|
| 22630-CPT | High | Arthrodesis, Posterior Interbody Technique, Including Laminectomy And/Or Discectomy To Prepare Interspace (Other Than For Decompression), Single Interspace; Lumbar |
| 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) |
| 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 |
| 22869-CPT | Moderate | Insertion Of Interlaminar/Interspinous Process Stabilization/Distraction Device Without Open Decompression Or Fusion Including Image Guidance When Performed Lumbar; Single Level |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22869. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 22869 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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