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CPT code 22533: Lumbar fusion, lateral extracavitary approach2026 Medicare rate & RVUs

Reports lumbar vertebral fusion using a lateral extracavitary approach, including limited disc-space preparation when it is performed as part of the fusion.

CMS RVU26DEffective Oct 1, 2026109 payment localities793 Medicare services in 2024

Medicare pays $1,547.80 for 22533 nationally in a facility.

Medicare rate · 22533

Lumbar fusion, lateral extracavitary approach

Office or facility?

Work RVUs
24.17
Total RVUs
46.34
Global days
090

National rate · 2026

$1,547.80

Facility setting, before claim adjustments.

See every locality for 22533 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 22533 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 22533 covers

This code describes fusion of a lumbar vertebral segment through a lateral extracavitary exposure. The surgeon reaches the spine through a lateral, posterior-side corridor and may remove a limited amount of disc tissue to prepare the space for fusion. That preparation is part of the service; the code is not for a discectomy performed to decompress neural structures. Spine surgeons typically perform the operation in a hospital operating room for a lumbar segment requiring stabilization and fusion.

Report 22533 for the lumbar level and use 22534 for each additional vertebral segment when applicable. The operative report should identify the lumbar level, approach, fusion work, and any additional segments. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment and co-surgeons are permitted; team surgery is not. Modifier 50 is inappropriate for this code.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 22533 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

22533 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,386.50
AlaskaUnavailable$1,885.24
ArizonaUnavailable$1,499.71
ArkansasUnavailable$1,366.86
Atlanta, GAUnavailable$1,603.22
Austin, TXUnavailable$1,554.10
Bakersfield, CAUnavailable$1,525.89
Baltimore area, MDUnavailable$1,651.25
Beaumont, TXUnavailable$1,485.38
Brazoria, TXUnavailable$1,500.65

22533 rates by state

Office rate range in each state. Select a state to see its payment localities.

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
22533 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 22533 rate is calculated

Each of 22533’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 22533

RVUs × geographic indexes × conversion factor

Office or facility?

Work24.17

24.17 RVUs× 1.000 GPCI

Practice expense15.51

15.51 RVUs× 1.000 GPCI

Malpractice6.66

6.66 RVUs× 1.000 GPCI

Adjusted RVUs

46.3400

Conversion factor

$33.4009

Medicare rate

$1,547.80

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 22533

22533 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22533

Lumbar fusion, lateral extracavitary approach

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)2Permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 22533

Lumbar fusion, lateral extracavitary approach

90-day global period ends

Dec 30, 2026

Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).

Visit on Oct 31, 2026

Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

22533 without 51 · national facility

$1,547.80

Lumbar fusion, lateral extracavitary approach

22533-51 · Second procedure: 50%

$773.90

When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).

When to use modifier 51

22533 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 22533

    Lumbar fusion, lateral extracavitary approach24.17 wRVU

    Not priced

  • 22532

    Spinal fusion, thoracic lateral extracavitary approach25.34 wRVU

    Not priced

  • 22534

    Spinal fusion, each additional segment5.84 wRVU

    Not priced

  • 22558

    Anterior fusion, lumbar, single interspace22.94 wRVU

    Not priced

  • 22612

    Spinal fusion, posterior lumbar, single level22.94 wRVU

    Not priced

How to choose

22532Spinal fusionThoracic lateral extracavitary approach
22532 is the thoracic counterpart in the lateral extracavitary fusion family. Use 22533 for the lumbar region.
22534Spinal fusionEach additional segment
22534 reports each additional vertebral segment; 22533 reports the initial lumbar segment.
22558Anterior fusionLumbar, single interspace
22558 describes lumbar interbody fusion through an anterior approach. 22533 is selected for the lateral extracavitary approach.
22612Spinal fusionPosterior lumbar, single level
22612 describes lumbar fusion using a posterior or posterolateral approach. 22533 is for the lateral extracavitary approach.

Codes related to 22533

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 22533
CodeHow it relatesNational office range
Add-on codes
22534Spinal fusion, each additional segmentAdd-on code for each additional vertebral segment treated after the initial segment.No office rate
Same family
22532Spinal fusion, thoracic lateral extracavitary approachUses the lateral extracavitary technique for thoracic rather than lumbar fusion.No office rate
Used instead
22558Anterior fusion, lumbar, single interspaceLumbar interbody fusion through an anterior approach rather than a lateral extracavitary approach.No office rate
22612Spinal fusion, posterior lumbar, single levelLumbar fusion using a posterior or posterolateral approach rather than the lateral extracavitary technique.No office rate

22533 billing questions

When is 22534 reported with 22533?

22534 is the add-on code for each additional vertebral segment treated after the initial lumbar segment reported with 22533. Document each level treated.

How does 22533 differ from 22558?

22533 describes lumbar fusion through a lateral extracavitary approach. 22558 describes lumbar interbody fusion through an anterior approach.

Is limited discectomy included?

Limited disc removal to prepare the interspace for fusion is included. The code describes preparation other than discectomy performed for decompression.

Can modifier 50 be used for bilateral work?

No. The descriptor and anatomy make modifier 50 inappropriate for 22533.

What payment rules affect multiple procedures and surgical assistance?

When procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Assistant-at-surgery payment and co-surgeons are permitted; team surgery is not.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 22533PPRRVU2026_Oct_nonQPP.csv, line 2,080 (RVU26D)

Open CMS sourceHow we calculate rates

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