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CPT code 22865: Disc removal, single lumbar interspace2026 Medicare rate & RVUs

Reports removal of an implanted artificial disc from one lumbar interspace when the prosthesis is explanted rather than revised or replaced.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $2,217.49 for 22865 nationally in a facility.

Medicare rate · 22865

Disc removal, single lumbar interspace

Office or facility?

Work RVUs
30.96
Total RVUs
66.39
Global days
090

National rate · 2026

$2,217.49

Facility setting, before claim adjustments.

See every locality for 22865 →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 22865 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 22865 covers

This code describes removal of an artificial disc prosthesis from a single lumbar interspace through an anterior approach. It applies when the surgeon explants the lumbar device without performing the revision or replacement service described by a different code. Spine surgeons typically perform the procedure in a hospital operating room; the record should identify the lumbar level, the existing prosthesis, the removal performed, and the clinical reason for explantation.

Medicare lists this service as restricted coverage, so payment is available only in specific circumstances. The major-surgery global period includes 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 the other procedures are paid at 50%. Modifier 50 is inappropriate for this code. Medicare may pay for an assistant at surgery, and co-surgeons and team surgery are permitted when their use is supported and applicable.

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 22865 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

22865 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,934.56
AlaskaUnavailable$2,586.89
ArizonaUnavailable$2,131.43
ArkansasUnavailable$1,900.34
Atlanta, GAUnavailable$2,320.35
Austin, TXUnavailable$2,213.05
Bakersfield, CAUnavailable$2,137.98
Baltimore area, MDUnavailable$2,392.07
Beaumont, TXUnavailable$2,119.28
Brazoria, TXUnavailable$2,122.93

22865 rates by state

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

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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
22865 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 22865 rate is calculated

Each of 22865’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 · 22865

RVUs × geographic indexes × conversion factor

Office or facility?

Work30.96

30.96 RVUs× 1.000 GPCI

Practice expense22.35

22.35 RVUs× 1.000 GPCI

Malpractice13.08

13.08 RVUs× 1.000 GPCI

Adjusted RVUs

66.3900

Conversion factor

$33.4009

Medicare rate

$2,217.49

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

Payment rules and modifiers for 22865

22865 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22865

Disc removal, single lumbar interspace

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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)2Permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.71/0.19Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 22865

Disc removal, single lumbar interspace

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

Pre-op dayGlobal period

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

22865 without 51 · national facility

$2,217.49

Disc removal, single lumbar interspace

22865-51 · Second procedure: 50%

$1,108.75

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%).

When to use modifier 51

22865 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 22865

    Disc removal, single lumbar interspace30.96 wRVU

    Not priced

  • 22862

    Disc revision, lumbar, one interspace31.81 wRVU

    Not priced

  • 22864

    Disc removal, cervical, single interspace28.67 wRVU

    Not priced

  • 22857

    Lumbar disc replacement, single interspace26.45 wRVU

    Not priced

  • 22855

    Hardware removal, anterior spinal instrumentation15.46 wRVU

    Not priced

How to choose

22862Disc revisionLumbar, one interspace
22865 describes removal without replacement. Use 22862 when the lumbar artificial disc is revised or replaced.
22864Disc removalCervical, single interspace
22864 is the corresponding artificial-disc removal service for a cervical interspace; 22865 is for a lumbar interspace.
22857Lumbar disc replacementSingle interspace
22857 describes initial lumbar artificial-disc implantation. It is not the code for removing an existing prosthesis.
22855Hardware removalAnterior spinal instrumentation
22855 addresses removal of anterior spinal instrumentation, not removal of an artificial disc prosthesis.

Codes related to 22865

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

Codes related to 22865
CodeHow it relatesNational office range
Same family
22864Disc removal, cervical, single interspaceCorresponding removal code for an artificial disc at a single cervical interspace.No office rate
22857Lumbar disc replacement, single interspaceLumbar artificial-disc procedure for initial implantation, rather than prosthesis removal.No office rate
22860Lumbar disc replacement, additional interspaceLumbar artificial-disc procedure for an additional interspace during implantation.No office rate
Used instead
22862Disc revision, lumbar, one interspaceUsed for revision or replacement of a lumbar artificial disc rather than explant alone.No office rate

22865 billing questions

When should 22865 be selected instead of 22862?

Use 22865 for removal of a lumbar artificial disc without revision or replacement. Code 22862 describes revision or replacement of the lumbar artificial disc.

Is 22865 reported for each lumbar level?

The code describes removal at one lumbar interspace. Document the level and the work performed; do not use it to represent removal at multiple interspaces with a single unit.

Can modifier 50 be appended for removal at two sides?

No. CMS identifies bilateral adjustment as inappropriate for this code; it does not describe a bilateral procedure.

What documentation supports Medicare coverage?

Document the specific lumbar interspace, the implanted artificial disc being removed, the removal performed, and the clinical circumstances supporting the explant. Medicare coverage is restricted to specific circumstances.

Does the global period include postoperative care?

Yes. The major-surgery global period includes the day-before preoperative visit and 90 days of related postoperative care.

Can an assistant or co-surgeon be reported?

Medicare may pay for an assistant at surgery, and co-surgeons and team surgery are permitted when supported by the case and applicable reporting requirements.

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 22865PPRRVU2026_Oct_nonQPP.csv, line 2,135 (RVU26D)

Open CMS sourceHow we calculate rates

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