CPT code 22859: Spinal implant, without interbody fusion2026 Medicare rate & RVUs in Puerto Rico
Reports placement of a biomechanical device in a spinal disc space or vertebral body defect when the reconstruction is performed without interbody arthrodesis.
In Puerto Rico, Medicare pays $300.03 for 22859 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 22859 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 22859 covers
A spine surgeon places a structural device, such as a cage or mesh, in an intervertebral disc space or vertebral body defect to support the anterior column without performing interbody arthrodesis. This may occur during operative reconstruction after a vertebral body resection for a tumor or another condition that leaves a defect. The work is typically performed in an operating room by an orthopedic spine surgeon or neurosurgeon.
Report this as an add-on with an eligible primary procedure, not as a stand-alone service. The device placement must be in a contiguous defect, and the operative report should identify the defect, device placement, and whether interbody arthrodesis was performed. Distinguish it from device placement performed in conjunction with arthrodesis, which is represented by other codes. CMS pays this add-on within the primary 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.
How Puerto Rico compares for 22859
Across 109 of 109 payment localities, the facility rate for 22859 runs from $255.67 in Wisconsin to $395.70 in Miami, FL. Puerto Rico pays $300.03. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$300.03
- Los Angeles, CA · California$298.25−$1.78
- Washington, DC area · District of Columbia$327.57+$27.54
- Miami, FL · Florida$395.70+$95.67
- Chicago, IL · Illinois$380.55+$80.52
- Manhattan, NY · New York$357.15+$57.12
- Alaska · Alaska$366.42+$66.39
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $266.33 |
| ArkansasArkansas | — | $262.27 |
| ArizonaArizona | — | $289.65 |
| Bakersfield, CACalifornia | — | $285.71 |
| Chico, CACalifornia | — | $280.91 |
| El Centro, CACalifornia | — | $281.22 |
| Fresno, CACalifornia | — | $280.91 |
| Hanford, CACalifornia | — | $280.91 |
| Madera, CACalifornia | — | $280.91 |
| Merced, CACalifornia | — | $280.91 |
| Modesto, CACalifornia | — | $280.91 |
| Napa, CACalifornia | — | $300.87 |
| Oxnard, CACalifornia | — | $293.37 |
| Redding, CACalifornia | — | $280.91 |
| Rest of CaliforniaCalifornia | — | $280.91 |
| Riverside, CACalifornia | — | $300.36 |
| Sacramento, CACalifornia | — | $288.37 |
| Salinas, CACalifornia | — | $287.23 |
| San Diego, CACalifornia | — | $289.65 |
| Marin County, CACalifornia | — | $309.18 |
| San Francisco, CACalifornia | — | $307.11 |
| San Benito County, CACalifornia | — | $318.48 |
| Santa Clara County, CACalifornia | — | $310.03 |
| San Luis Obispo, CACalifornia | — | $283.51 |
| Santa Cruz, CACalifornia | — | $288.83 |
| Santa Maria, CACalifornia | — | $287.12 |
| Santa Rosa, CACalifornia | — | $291.22 |
| Stockton, CACalifornia | — | $280.91 |
| Vallejo, CACalifornia | — | $297.89 |
| Visalia, CACalifornia | — | $280.91 |
| Yuba City, CACalifornia | — | $280.91 |
| ColoradoColorado | — | $292.98 |
| ConnecticutConnecticut | — | $321.28 |
| DelawareDelaware | — | $294.30 |
| Fort Lauderdale, FLFlorida | — | $350.18 |
| Rest of FloridaFlorida | — | $328.19 |
| Atlanta, GAGeorgia | — | $314.00 |
| Rest of GeorgiaGeorgia | — | $305.42 |
| Hawaii, Guam, HIHawaii | — | $282.96 |
| IowaIowa | — | $258.48 |
| IdahoIdaho | — | $263.40 |
| East St. Louis, ILIllinois | — | $357.08 |
| Rest of IllinoisIllinois | — | $329.24 |
| Suburban Chicago, ILIllinois | — | $350.09 |
| IndianaIndiana | — | $264.61 |
| KansasKansas | — | $264.32 |
| KentuckyKentucky | — | $288.40 |
| New Orleans, LALouisiana | — | $304.97 |
| Rest of LouisianaLouisiana | — | $290.77 |
| Metropolitan Boston, MAMassachusetts | — | $312.66 |
| Rest of MassachusettsMassachusetts | — | $294.00 |
| Baltimore area, MDMaryland | — | $321.96 |
| Rest of MarylandMaryland | — | $297.81 |
| Rest of MaineMaine | — | $272.46 |
| Southern Maine, MEMaine | — | $277.30 |
| Detroit, MIMichigan | — | $339.86 |
| Rest of MichiganMichigan | — | $302.86 |
| MinnesotaMinnesota | — | $259.23 |
| Metropolitan Kansas City, MOMissouri | — | $295.19 |
| Metropolitan St. Louis, MOMissouri | — | $297.49 |
| Rest of MissouriMissouri | — | $290.35 |
| MississippiMississippi | — | $276.00 |
| MontanaMontana | — | $300.15 |
| North CarolinaNorth Carolina | — | $274.28 |
| North DakotaNorth Dakota | — | $264.17 |
| NebraskaNebraska | — | $257.81 |
| New HampshireNew Hampshire | — | $295.15 |
| Northern New JerseyNew Jersey | — | $325.36 |
| Rest of New JerseyNew Jersey | — | $318.89 |
| New MexicoNew Mexico | — | $307.47 |
| NevadaNevada | — | $290.18 |
| NYC suburbs and Long Island, NYNew York | — | $375.25 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $326.84 |
| Queens, NYNew York | — | $349.60 |
| Rest of New YorkNew York | — | $279.20 |
| OhioOhio | — | $295.50 |
| OklahomaOklahoma | — | $280.25 |
| Portland, OROregon | — | $294.29 |
| Rest of OregonOregon | — | $281.98 |
| Metropolitan Philadelphia, PAPennsylvania | — | $317.71 |
| Rest of PennsylvaniaPennsylvania | — | $291.97 |
| Rhode IslandRhode Island | — | $299.11 |
| South CarolinaSouth Carolina | — | $286.56 |
| South DakotaSouth Dakota | — | $259.91 |
| TennesseeTennessee | — | $266.63 |
| Austin, TXTexas | — | $297.21 |
| Beaumont, TXTexas | — | $290.52 |
| Brazoria, TXTexas | — | $287.79 |
| Dallas, TXTexas | — | $293.01 |
| Fort Worth, TXTexas | — | $293.20 |
| Galveston, TXTexas | — | $290.83 |
| Houston, TXTexas | — | $324.14 |
| Rest of TexasTexas | — | $291.29 |
| UtahUtah | — | $290.45 |
| VirginiaVirginia | — | $281.37 |
| Virgin Islands, VIUnited States Virgin Islands | — | $300.03 |
| VermontVermont | — | $269.64 |
| Rest of WashingtonWashington | — | $291.28 |
| King County, WAWashington | — | $311.82 |
| WisconsinWisconsin | — | $255.67 |
| West VirginiaWest Virginia | — | $318.55 |
| WyomingWyoming | — | $284.47 |
22859 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 22859 rate is calculated
Each of 22859’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 · 22859
RVUs × geographic indexes × conversion factor
Work5.36
5.36 RVUs× 1.000 GPCI
Practice expense1.81
1.81 RVUs× 1.000 GPCI
Malpractice1.82
1.82 RVUs× 1.000 GPCI
Adjusted RVUs
8.9900
Conversion factor
$33.4009
Medicare rate
$300.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
2,130
- Code
- 22859
- Physician work
- 5.36
- Practice expense
- 1.81
- Malpractice
- 1.82
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 5.36 | × 1.000 | 5.3600 |
| Practice expense | 1.81 | × 1.011 | 1.8299 |
| Malpractice | 1.82 | × 0.985 | 1.7927 |
| Total RVUs | 8.9826 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Puerto Rico$300.03
Facility: (5.36 × 1 + 1.81 × 1.011 + 1.82 × 0.985) × $33.4009 = $300.03
Payment rules and modifiers for 22859
The CMS indicators that decide how 22859 is paid alongside other services.
CMS payment indicators · 22859
Spinal implant, without interbody fusion
| 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
22859 without 80 · national facility
$300.27
Spinal implant, without interbody fusion
22859-80 · Assistant: 16%
$48.04
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
How 22859 has changed in Puerto Rico
22859 · 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
January 1, 2017
RVU17A
No ratechanged toNo rate
Held through RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $300.03 | RVU26D |
| 2026-07-01 | Not available in this setting | $300.03 | RVU26C |
| 2026-04-01 | Not available in this setting | $300.03 | RVU26B |
| 2026-01-01 | Not available in this setting | $300.03 | RVU26A |
| 2025-10-01 | Not available in this setting | $325.31 | RVU25D |
| 2025-07-01 | Not available in this setting | $325.31 | RVU25C |
| 2025-04-01 | Not available in this setting | $325.31 | RVU25B |
| 2025-01-01 | Not available in this setting | $325.31 | RVU25A |
| 2024-10-01 | Not available in this setting | $331.13 | RVU24D |
| 2024-07-01 | Not available in this setting | $331.13 | RVU24C |
| 2024-04-01 | Not available in this setting | $331.13 | RVU24B |
| 2024-03-09 | Not available in this setting | $331.13 | RVU24AR |
| 2024-01-01 | Not available in this setting | $325.73 | RVU24A |
| 2023-10-01 | Not available in this setting | $335.66 | RVU23D |
| 2023-07-01 | Not available in this setting | $335.82 | RVU23C |
| 2023-04-01 | Not available in this setting | $335.82 | RVU23B |
| 2023-01-01 | Not available in this setting | $335.82 | RVU23A |
| 2022-10-01 | Not available in this setting | $339.80 | RVU22D |
| 2022-07-01 | Not available in this setting | $339.80 | RVU22C |
| 2022-04-01 | Not available in this setting | $339.80 | RVU22B |
| 2022-01-01 | Not available in this setting | $339.80 | RVU22A |
| 2021-10-01 | Not available in this setting | $342.28 | RVU21D |
| 2021-07-01 | Not available in this setting | $342.28 | RVU21C |
| 2021-04-01 | Not available in this setting | $342.28 | RVU21B |
| 2021-01-01 | Not available in this setting | $342.28 | RVU21A |
| 2020-10-01 | Not available in this setting | $351.57 | RVU20D |
| 2020-07-01 | Not available in this setting | $351.57 | RVU20C |
| 2020-04-01 | Not available in this setting | $351.57 | RVU20B |
| 2020-01-01 | Not available in this setting | $351.57 | RVU20A |
| 2019-10-01 | Not available in this setting | $352.53 | RVU19D |
| 2019-07-01 | Not available in this setting | $352.53 | RVU19C |
| 2019-04-01 | Not available in this setting | $352.53 | RVU19B |
| 2019-01-01 | Not available in this setting | $352.53 | RVU19A |
| 2018-10-01 | Not available in this setting | $339.66 | RVU18D |
| 2018-07-01 | Not available in this setting | $339.66 | RVU18C |
| 2018-04-01 | Not available in this setting | $339.66 | RVU18B |
| 2018-01-01 | Not available in this setting | $339.66 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $318.73 | RVU17D |
| 2017-07-01 | Not available in this setting | $318.73 | RVU17C |
| 2017-04-01 | Not available in this setting | $318.73 | RVU17B |
| 2017-01-01 | Not available in this setting | $318.73 | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
22859 billing questions
How does this differ from 22853 or 22854?
Use 22859 when the device is placed without interbody arthrodesis. Codes 22853 and 22854 describe device placement in conjunction with interbody arthrodesis, with the code choice depending on the defect addressed.
Can 22859 be billed by itself?
No. It is an add-on code and must be reported with an eligible primary procedure.
How many units are reported?
The code is reported for each contiguous defect. The operative documentation should support the number and location of the defects treated.
What documentation supports reporting 22859?
Document the spinal disc-space or vertebral-body defect, the biomechanical device placed, and that interbody arthrodesis was not performed. The record should also identify the primary procedure reported with this add-on.
How does Medicare handle the global period?
CMS pays this add-on within the global period of the primary procedure. It does not establish a separate 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
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