CPT code 22614: Spinal fusion, each additional level2026 Medicare rate & RVUs in Guam
Reports each additional vertebral level fused using a posterior or posterolateral approach, alongside the applicable primary fusion code.
CMS doesn’t publish an office rate for 22614 in Guam.
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 22614 covers
This add-on describes an additional spinal level fused through a posterior or posterolateral approach. Spine surgeons, including orthopedic spine surgeons and neurosurgeons, may perform multilevel fusion in an operating room for conditions such as spinal instability or degenerative disease. The surgeon’s operative report should identify the vertebral levels treated and the fusion technique used.
Report 22614 for each additional level after the primary posterior or posterolateral fusion code, such as 22600 for cervical, 22610 for thoracic, or 22612 for lumbar fusion. It cannot be reported by itself. Documentation should distinguish each fused level from instrumentation or other work performed at the same levels. CMS treats 22614 as an add-on code: 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.
22614 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | $329.78 |
How the 22614 rate is calculated
Each of 22614’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 · 22614
RVUs × geographic indexes × conversion factor
Work6.27
6.27 RVUs× 1.000 GPCI
Practice expense2.11
2.11 RVUs× 1.000 GPCI
Malpractice2.08
2.08 RVUs× 1.000 GPCI
Adjusted RVUs
10.4600
Conversion factor
$33.4009
Medicare rate
$349.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 22614
The CMS indicators that decide how 22614 is paid alongside other services.
CMS payment indicators · 22614
Spinal fusion, each additional level
| 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
22614 without 80 · national facility
$349.37
Spinal fusion, each additional level
22614-80 · Assistant: 16%
$55.90
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
22614 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 22612Spinal fusionPosterior lumbar, single level
- 22612 is the primary code for a lumbar posterior or posterolateral fusion level; 22614 reports each additional level.
- 22632Lumbar fusionEach additional interspace
- 22632 is for an additional lumbar level fused through a posterior interbody approach, rather than the posterior or posterolateral technique represented by 22614.
- 22634Lumbar fusionEach additional interspace
- 22634 describes an additional lumbar level treated with both posterior or posterolateral and interbody fusion techniques; 22614 represents the posterior or posterolateral fusion level.
22614 billing questions
Can 22614 be reported by itself?
No. It is an add-on for an additional fusion level and must be billed with the applicable primary posterior or posterolateral fusion code.
How many units should be reported?
Report one unit for each additional vertebral level treated after the primary level. The operative report should identify the levels fused.
How is 22614 different from 22612?
22612 describes the primary lumbar posterior or posterolateral fusion level. Use 22614 for each additional level in that fusion.
How is 22614 different from 22632?
22614 represents an additional level of posterior or posterolateral fusion. 22632 represents an additional level of lumbar posterior interbody fusion.
Does instrumentation determine the number of 22614 units?
No. Units follow the additional vertebral fusion levels documented, not the number of implants or fixation points.
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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