CPT code 22534: Spinal fusion, each additional segment2026 Medicare rate & RVUs in California
Reports an additional thoracic or lumbar vertebral segment fused through a lateral extracavitary approach, alongside the applicable primary arthrodesis code.
CMS doesn’t publish an office rate for 22534 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $308.64 |
| Chico, CA | Unavailable | $303.59 |
| El Centro, CA | Unavailable | $303.91 |
| Fresno, CA | Unavailable | $303.59 |
| Hanford, CA | Unavailable | $303.59 |
| Los Angeles, CA | Unavailable | $322.07 |
| Madera, CA | Unavailable | $303.59 |
| Marin County, CA | Unavailable | $334.24 |
| Merced, CA | Unavailable | $303.59 |
| Modesto, CA | Unavailable | $303.59 |
| Napa, CA | Unavailable | $325.16 |
| Oxnard, CA | Unavailable | $316.86 |
| Redding, CA | Unavailable | $303.59 |
| Rest of California | Unavailable | $303.59 |
| Riverside, CA | Unavailable | $324.01 |
| Sacramento, CA | Unavailable | $311.64 |
| Salinas, CA | Unavailable | $310.40 |
| San Benito County, CA | Unavailable | $344.15 |
| San Diego, CA | Unavailable | $312.99 |
| San Francisco, CA | Unavailable | $332.07 |
| San Luis Obispo, CA | Unavailable | $306.38 |
| Santa Clara County, CA | Unavailable | $335.28 |
| Santa Cruz, CA | Unavailable | $312.08 |
| Santa Maria, CA | Unavailable | $310.27 |
| Santa Rosa, CA | Unavailable | $314.68 |
| Stockton, CA | Unavailable | $303.59 |
| Vallejo, CA | Unavailable | $322.04 |
| Visalia, CA | Unavailable | $303.59 |
| Yuba City, CA | Unavailable | $303.59 |
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
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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.
22534 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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