CPT code 22865: Disc removal, single lumbar interspace2026 Medicare rate & RVUs in Massachusetts
Reports removal of an implanted artificial disc from one lumbar interspace when the prosthesis is explanted rather than revised or replaced.
CMS doesn’t publish an office rate for 22865 in Massachusetts.
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 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 in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | $2,356.65 |
| Rest of Massachusetts | Unavailable | $2,184.91 |
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
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
| 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) | 2 | Permitted. |
| Team surgery (66) | 2 | Permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.71/0.19 | Share 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.
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%).
22865 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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