CPT code 22849: Spinal fixation, reinsertion of existing device2026 Medicare rate & RVUs in Nevada
Reports reinsertion of a previously placed spinal fixation device during spine surgery, rather than initial placement of a new fixation construct.
In Nevada, Medicare pays $1,194.98 for 22849 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 22849 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 22849 covers
A spine surgeon reports this service when a previously placed fixation device is reinserted as part of an operation, such as a revision procedure in which the existing device is removed and then returned to the spine. The operative report should identify the prior fixation and describe the steps supporting reinsertion; simply placing a new construct is not this service. These procedures are generally performed in a hospital or ambulatory surgical setting.
Choose this code for reinsertion, not by counting vertebral segments or selecting the code for initial placement. Document the device and the reason it was reinserted, along with any related fusion or instrumentation work. Medicare assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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.
How Nevada compares for 22849
Across 109 of 109 payment localities, the facility rate for 22849 runs from $1,075.20 in Nebraska to $1,538.79 in Miami, FL. Nevada pays $1,194.98. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Nevada · this page$1,194.98
- Los Angeles, CA · California$1,262.48+$67.50
- Washington, DC area · District of Columbia$1,355.23+$160.25
- Miami, FL · Florida$1,538.79+$343.81
- Chicago, IL · Illinois$1,483.24+$288.26
- Manhattan, NY · New York$1,446.24+$251.26
- Alaska · Alaska$1,478.88+$283.90
Other areas in Nevada first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $1,091.84 |
| ArkansasArkansas | — | $1,075.44 |
| ArizonaArizona | — | $1,186.32 |
| Bakersfield, CACalifornia | — | $1,202.50 |
| Chico, CACalifornia | — | $1,187.16 |
| El Centro, CACalifornia | — | $1,188.13 |
| Fresno, CACalifornia | — | $1,187.16 |
| Hanford, CACalifornia | — | $1,187.16 |
| Madera, CACalifornia | — | $1,187.16 |
| Merced, CACalifornia | — | $1,187.16 |
| Modesto, CACalifornia | — | $1,187.16 |
| Napa, CACalifornia | — | $1,301.38 |
| Oxnard, CACalifornia | — | $1,246.04 |
| Redding, CACalifornia | — | $1,187.16 |
| Rest of CaliforniaCalifornia | — | $1,187.16 |
| Riverside, CACalifornia | — | $1,248.98 |
| Sacramento, CACalifornia | — | $1,226.46 |
| Salinas, CACalifornia | — | $1,221.70 |
| San Diego, CACalifornia | — | $1,237.38 |
| Marin County, CACalifornia | — | $1,349.57 |
| San Francisco, CACalifornia | — | $1,343.01 |
| San Benito County, CACalifornia | — | $1,386.90 |
| Santa Clara County, CACalifornia | — | $1,360.07 |
| San Luis Obispo, CACalifornia | — | $1,204.77 |
| Santa Cruz, CACalifornia | — | $1,238.39 |
| Santa Maria, CACalifornia | — | $1,222.69 |
| Santa Rosa, CACalifornia | — | $1,249.33 |
| Stockton, CACalifornia | — | $1,187.16 |
| Vallejo, CACalifornia | — | $1,291.92 |
| Visalia, CACalifornia | — | $1,187.16 |
| Yuba City, CACalifornia | — | $1,187.16 |
| ColoradoColorado | — | $1,218.23 |
| ConnecticutConnecticut | — | $1,311.37 |
| DelawareDelaware | — | $1,205.52 |
| Fort Lauderdale, FLFlorida | — | $1,388.13 |
| Rest of FloridaFlorida | — | $1,305.91 |
| Atlanta, GAGeorgia | — | $1,274.04 |
| Rest of GeorgiaGeorgia | — | $1,219.66 |
| Hawaii, Guam, HIHawaii | — | $1,201.64 |
| IowaIowa | — | $1,075.59 |
| IdahoIdaho | — | $1,092.31 |
| East St. Louis, ILIllinois | — | $1,389.82 |
| Rest of IllinoisIllinois | — | $1,299.88 |
| Suburban Chicago, ILIllinois | — | $1,391.28 |
| IndianaIndiana | — | $1,097.69 |
| KansasKansas | — | $1,091.75 |
| KentuckyKentucky | — | $1,164.95 |
| New Orleans, LALouisiana | — | $1,228.91 |
| Rest of LouisianaLouisiana | — | $1,171.61 |
| Metropolitan Boston, MAMassachusetts | — | $1,310.62 |
| Rest of MassachusettsMassachusetts | — | $1,219.32 |
| Baltimore area, MDMaryland | — | $1,312.45 |
| Rest of MarylandMaryland | — | $1,222.14 |
| Rest of MaineMaine | — | $1,121.08 |
| Southern Maine, MEMaine | — | $1,151.89 |
| Detroit, MIMichigan | — | $1,344.92 |
| Rest of MichiganMichigan | — | $1,216.09 |
| MinnesotaMinnesota | — | $1,102.78 |
| Metropolitan Kansas City, MOMissouri | — | $1,197.40 |
| Metropolitan St. Louis, MOMissouri | — | $1,207.55 |
| Rest of MissouriMissouri | — | $1,165.29 |
| MississippiMississippi | — | $1,119.51 |
| MontanaMontana | — | $1,226.43 |
| North CarolinaNorth Carolina | — | $1,129.69 |
| North DakotaNorth Dakota | — | $1,112.14 |
| NebraskaNebraska | — | $1,075.20 |
| New HampshireNew Hampshire | — | $1,219.47 |
| Northern New JerseyNew Jersey | — | $1,344.79 |
| Rest of New JerseyNew Jersey | — | $1,308.19 |
| New MexicoNew Mexico | — | $1,231.63 |
| NYC suburbs and Long Island, NYNew York | — | $1,509.61 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $1,334.35 |
| Queens, NYNew York | — | $1,426.63 |
| Rest of New YorkNew York | — | $1,149.00 |
| OhioOhio | — | $1,192.73 |
| OklahomaOklahoma | — | $1,139.95 |
| Portland, OROregon | — | $1,232.83 |
| Rest of OregonOregon | — | $1,167.84 |
| Metropolitan Philadelphia, PAPennsylvania | — | $1,292.10 |
| Rest of PennsylvaniaPennsylvania | — | $1,182.62 |
| Puerto RicoPuerto Rico | — | $1,228.42 |
| Rhode IslandRhode Island | — | $1,231.34 |
| South CarolinaSouth Carolina | — | $1,166.73 |
| South DakotaSouth Dakota | — | $1,098.63 |
| TennesseeTennessee | — | $1,100.17 |
| Austin, TXTexas | — | $1,229.81 |
| Beaumont, TXTexas | — | $1,176.25 |
| Brazoria, TXTexas | — | $1,185.65 |
| Dallas, TXTexas | — | $1,203.38 |
| Fort Worth, TXTexas | — | $1,201.80 |
| Galveston, TXTexas | — | $1,195.74 |
| Houston, TXTexas | — | $1,301.53 |
| Rest of TexasTexas | — | $1,187.20 |
| UtahUtah | — | $1,182.55 |
| VirginiaVirginia | — | $1,163.09 |
| Virgin Islands, VIUnited States Virgin Islands | — | $1,228.42 |
| VermontVermont | — | $1,127.35 |
| Rest of WashingtonWashington | — | $1,210.49 |
| King County, WAWashington | — | $1,315.65 |
| WisconsinWisconsin | — | $1,076.02 |
| West VirginiaWest Virginia | — | $1,256.38 |
| WyomingWyoming | — | $1,176.62 |
22849 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
How the 22849 rate is calculated
Each of 22849’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 · 22849
RVUs × geographic indexes × conversion factor
Work18.69
18.69 RVUs× 1.000 GPCI
Practice expense12.26
12.26 RVUs× 1.000 GPCI
Malpractice5.78
5.78 RVUs× 1.000 GPCI
Adjusted RVUs
36.7300
Conversion factor
$33.4009
Medicare rate
$1,226.82
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Nevada inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
2,121
- Code
- 22849
- Physician work
- 18.69
- Practice expense
- 12.26
- Malpractice
- 5.78
GPCI2026.csv
73
- Locality
- Nevada
- Physician work
- 1.000
- Practice expense
- 1.001
- Malpractice
- 0.833
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.69 | × 1.000 | 18.6900 |
| Practice expense | 12.26 | × 1.001 | 12.2723 |
| Malpractice | 5.78 | × 0.833 | 4.8147 |
| Total RVUs | 35.7770 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Nevada$1194.98
Facility: (18.69 × 1 + 12.26 × 1.001 + 5.78 × 0.833) × $33.4009 = $1194.98
Payment rules and modifiers for 22849
22849 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 22849
Spinal fixation, reinsertion of existing device
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 22849
Spinal fixation, reinsertion of existing device
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.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
22849 without 51 · national facility
$1,226.82
Spinal fixation, reinsertion of existing device
22849-51 · Second procedure: 50%
$613.41
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%).
How 22849 has changed in Nevada
22849 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $1,194.98 | RVU26D |
| 2026-07-01 | Not available in this setting | $1,194.98 | RVU26C |
| 2026-04-01 | Not available in this setting | $1,194.98 | RVU26B |
| 2026-01-01 | Not available in this setting | $1,194.98 | RVU26A |
| 2025-10-01 | Not available in this setting | $1,257.83 | RVU25D |
| 2025-07-01 | Not available in this setting | $1,257.83 | RVU25C |
| 2025-04-01 | Not available in this setting | $1,257.83 | RVU25B |
| 2025-01-01 | Not available in this setting | $1,257.83 | RVU25A |
| 2024-10-01 | Not available in this setting | $1,285.84 | RVU24D |
| 2024-07-01 | Not available in this setting | $1,285.84 | RVU24C |
| 2024-04-01 | Not available in this setting | $1,285.84 | RVU24B |
| 2024-03-09 | Not available in this setting | $1,285.84 | RVU24AR |
| 2024-01-01 | Not available in this setting | $1,264.85 | RVU24A |
| 2023-10-01 | Not available in this setting | $1,348.03 | RVU23D |
| 2023-07-01 | Not available in this setting | $1,348.03 | RVU23C |
| 2023-04-01 | Not available in this setting | $1,348.03 | RVU23B |
| 2023-01-01 | Not available in this setting | $1,348.03 | RVU23A |
| 2022-10-01 | Not available in this setting | $1,412.50 | RVU22D |
| 2022-07-01 | Not available in this setting | $1,412.50 | RVU22C |
| 2022-04-01 | Not available in this setting | $1,412.50 | RVU22B |
| 2022-01-01 | Not available in this setting | $1,412.50 | RVU22A |
| 2021-10-01 | Not available in this setting | $1,416.11 | RVU21D |
| 2021-07-01 | Not available in this setting | $1,416.11 | RVU21C |
| 2021-04-01 | Not available in this setting | $1,416.11 | RVU21B |
| 2021-01-01 | Not available in this setting | $1,416.11 | RVU21A |
| 2020-10-01 | Not available in this setting | $1,389.78 | RVU20D |
| 2020-07-01 | Not available in this setting | $1,389.78 | RVU20C |
| 2020-04-01 | Not available in this setting | $1,389.78 | RVU20B |
| 2020-01-01 | Not available in this setting | $1,389.78 | RVU20A |
| 2019-10-01 | Not available in this setting | $1,351.65 | RVU19D |
| 2019-07-01 | Not available in this setting | $1,351.65 | RVU19C |
| 2019-04-01 | Not available in this setting | $1,351.65 | RVU19B |
| 2019-01-01 | Not available in this setting | $1,351.65 | RVU19A |
| 2018-10-01 | Not available in this setting | $1,350.20 | RVU18D |
| 2018-07-01 | Not available in this setting | $1,350.20 | RVU18C |
| 2018-04-01 | Not available in this setting | $1,350.20 | RVU18B |
| 2018-01-01 | Not available in this setting | $1,350.20 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $1,363.23 | RVU17D |
| 2017-07-01 | Not available in this setting | $1,363.23 | RVU17C |
| 2017-04-01 | Not available in this setting | $1,363.23 | RVU17B |
| 2017-01-01 | Not available in this setting | $1,363.23 | RVU17A |
| 2016-10-01 | Not available in this setting | $1,378.14 | RVU16D |
| 2016-07-01 | Not available in this setting | $1,378.14 | RVU16C |
| 2016-04-01 | Not available in this setting | $1,378.14 | RVU16B |
| 2016-01-01 | Not available in this setting | $1,378.14 | RVU16A |
| 2015-10-01 | Not available in this setting | $1,389.14 | RVU15D |
| 2015-07-01 | Not available in this setting | $1,389.14 | RVU15C |
| 2015-04-01 | Not available in this setting | $1,382.23 | RVU15B |
| 2015-01-01 | Not available in this setting | $1,382.23 | RVU15A |
| 2014-10-01 | Not available in this setting | $1,381.76 | RVU14D |
| 2014-07-01 | Not available in this setting | $1,381.76 | RVU14C |
| 2014-04-01 | Not available in this setting | $1,381.76 | RVU14B |
| 2014-01-01 | Not available in this setting | $1,381.76 | RVU14A |
| 2013-10-01 | Not available in this setting | $1,382.42 | RVU13D |
| 2013-07-01 | Not available in this setting | Rate data unavailable | RVU13C |
| 2013-04-01 | Not available in this setting | Rate data unavailable | RVU13B |
| 2013-01-01 | Not available in this setting | Rate data unavailable | RVU13AR |
Where the Nevada rate applies
Nevada is a Medicare payment area, not a city. Our Census mapping connects it to 138 cities and communities in Nevada. Some span more than one payment area; confirm with the service ZIP.
- Alamo
- Amargosa Valley
- Austin
- Baker
- Battle Mountain
- Beatty
- Beaverdam
- Bennett Springs
22849 billing questions
How is reinsertion different from initial spinal fixation placement?
Use 22849 when a previously placed fixation device is reinserted. Initial placement of a new construct is reported with the applicable insertion code, selected for the approach and construct.
What operative documentation supports 22849?
Identify the previously placed device and describe its removal and reinsertion during the operation. The record should make clear that the service was reinsertion rather than placement of a new construct.
Can removal of the existing device be reported separately?
The operative report should distinguish any removal work from reinsertion. Do not assume a separate removal code is supported solely because the device was handled during the reinsertion procedure.
Does modifier 50 apply when fixation is reinserted on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
What Medicare postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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
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