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CPT code 22534: Spinal fusion, each additional segment2026 Medicare rate & RVUs

Reports an additional thoracic or lumbar vertebral segment fused through a lateral extracavitary approach, alongside the applicable primary arthrodesis code.

CMS RVU26DEffective Oct 1, 2026109 payment localities856 Medicare services in 2024

Medicare pays $323.65 for 22534 nationally in a facility.

Medicare rate · 22534

Spinal fusion, each additional segment

Office or facility?

Work RVUs
5.84
Total RVUs
9.69
Global days
ZZZ

National rate · 2026

$323.65

Facility setting, before claim adjustments.

See every locality for 22534 →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 22534 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 22534 covers

This add-on represents fusion of an additional vertebral segment using a lateral extracavitary approach to the thoracic or lumbar spine. The surgeon prepares the interspace for fusion, including limited disc removal for that purpose; the code does not describe disc removal performed as decompression. Orthopedic spine surgeons and neurosurgeons typically report it for multilevel fusion performed in an operating room.

Report 22534 for each additional segment beyond the segment represented by the primary procedure. The operative report should identify the spinal levels fused and support the lateral extracavitary technique; select the primary code according to the region of the initial segment. CMS treats 22534 as an add-on: it is billed only with a primary procedure and paid within that procedure’s global period.

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 22534 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

22534 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$287.87
AlaskaUnavailable$396.75
ArizonaUnavailable$312.46
ArkansasUnavailable$283.58
Atlanta, GAUnavailable$338.10
Austin, TXUnavailable$320.53
Bakersfield, CAUnavailable$308.64
Baltimore area, MDUnavailable$346.63
Beaumont, TXUnavailable$313.29
Brazoria, TXUnavailable$310.60

22534 rates by state

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

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Explore a state

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
22534 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 22534 rate is calculated

Each of 22534’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 · 22534

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.84

5.84 RVUs× 1.000 GPCI

Practice expense1.94

1.94 RVUs× 1.000 GPCI

Malpractice1.91

1.91 RVUs× 1.000 GPCI

Adjusted RVUs

9.6900

Conversion factor

$33.4009

Medicare rate

$323.65

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

Payment rules and modifiers for 22534

The CMS indicators that decide how 22534 is paid alongside other services.

CMS payment indicators · 22534

Spinal fusion, each additional segment

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

22534 without 80 · national facility

$323.65

Spinal fusion, each additional segment

22534-80 · Assistant: 16%

$51.78

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

22534 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 22534

    Spinal fusion, each additional segment5.84 wRVU

    Not priced

  • 22532

    Spinal fusion, thoracic lateral extracavitary approach25.34 wRVU

    Not priced

  • 22533

    Lumbar fusion, lateral extracavitary approach24.17 wRVU

    Not priced

  • 22585

    Anterior fusion, additional interspace5.38 wRVU

    Not priced

How to choose

22532Spinal fusionThoracic lateral extracavitary approach
22532 represents the primary thoracic lateral extracavitary fusion segment. Use 22534 for each additional segment, not for the initial segment.
22533Lumbar fusionLateral extracavitary approach
22533 represents the primary lumbar lateral extracavitary fusion segment. 22534 reports additional segments rather than the primary lumbar fusion.
22585Anterior fusionAdditional interspace
22585 is an additional-level code for anterior interbody arthrodesis. 22534 is for additional segments fused through the lateral extracavitary approach.

Codes related to 22534

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

Codes related to 22534
CodeHow it relatesNational office range
Primary code
22532Spinal fusion, thoracic lateral extracavitary approachThoracic lateral extracavitary arthrodesis serving as the primary procedure.No office rate
22533Lumbar fusion, lateral extracavitary approachLumbar lateral extracavitary arthrodesis serving as the primary procedure.No office rate
Used instead
22585Anterior fusion, additional interspaceAdditional-level arthrodesis code for an anterior interbody approach, rather than lateral extracavitary fusion.No office rate

22534 billing questions

Which primary code is reported with 22534?

Use 22532 for a thoracic primary segment or 22533 for a lumbar primary segment. 22534 represents an additional segment, not the primary fusion.

Can 22534 be submitted by itself?

No. It is an add-on code and must be billed with its applicable primary arthrodesis procedure.

How many units of 22534 should be reported?

Report a unit for each additional vertebral segment treated beyond the segment represented by the primary code. The operative report should identify the fused levels.

Is disc preparation included?

Limited disc removal to prepare the fusion interspace is part of the service. The code does not represent disc removal performed for decompression.

How does CMS treat payment for 22534?

CMS treats it as an add-on billed with a primary procedure and pays it within that procedure’s global period.

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 22534PPRRVU2026_Oct_nonQPP.csv, line 2,081 (RVU26D)

Open CMS sourceHow we calculate rates

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