No office rate
Use 22595 for posterior C1-C2 arthrodesis. Use 22548 when the fusion is performed through an anterior transoral or transpharyngeal approach.
On this page
CMS RVU26D · Effective 2026-10-01
22548 C1-C2 fusion Medicare reimbursement rates
Anterior transoral or transpharyngeal fusion of C1-C2 is reported for selected atlantoaxial disorders requiring stabilization, often with ventral decompression. Compare 22548 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 22548?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 22548 pays more and less
Spinal arthrodesis
About 22548: Anterior transoral C1-C2 fusion
Anterior transoral or transpharyngeal fusion of C1-C2 is reported for selected atlantoaxial disorders requiring stabilization, often with ventral decompression.
This code represents fusion of the atlas and axis through an approach via the mouth or pharynx. The surgeon may remove the odontoid process to relieve ventral compression before stabilizing the joint. Typical situations include odontoid-related compression of the upper spinal cord or brainstem and complex atlantoaxial instability. A neurosurgeon or orthopedic spine surgeon performs the operation in a hospital operating room; another surgeon may assist with exposure or participate as a co-surgeon.
Report the code when the operative documentation supports an anterior transoral or transpharyngeal C1-C2 arthrodesis. Document the indication, levels, approach, fusion work, and whether odontoidectomy was performed. This major surgery has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is not appropriate for this single midline procedure. Assistant-at-surgery payment and co-surgeons are permitted; team surgery is not permitted.
CMS billing rules for 22548
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU26.38 · 45%
- Practice expense (office) RVU20.66 · 36%
- Malpractice RVU11.15 · 19%
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.
22548 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
22590 describes posterior craniocervical arthrodesis, generally involving the occiput and upper cervical spine. 22548 is an anterior transoral or transpharyngeal C1-C2 fusion.
No office rate
22551 is anterior interbody fusion in the cervical spine with discectomy, typically at subaxial levels. It is not the transoral C1-C2 arthrodesis described by 22548.
See how rates vary across the country
22548 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | 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 |
Compare 22548 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $1695.71 |
| Alaska* | Office Unavailable | Facility $2261.79 |
| Arizona | Office Unavailable | Facility $1868.58 |
| Arkansas | Office Unavailable | Facility $1665.68 |
| Atlanta | Office Unavailable | Facility $2032.14 |
| Austin | Office Unavailable | Facility $1942.93 |
| Bakersfield | Office Unavailable | Facility $1880.97 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $2096.33 |
| Beaumont | Office Unavailable | Facility $1855.05 |
| Brazoria | Office Unavailable | Facility $1862.50 |
| Chicago | Office Unavailable | Facility $2435.50 |
| Chico | Office Unavailable | Facility $1852.02 |
| Colorado | Office Unavailable | Facility $1916.78 |
| Connecticut | Office Unavailable | Facility $2092.56 |
| Dallas | Office Unavailable | Facility $1895.88 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $2156.09 |
| Delaware | Office Unavailable | Facility $1902.11 |
| Detroit | Office Unavailable | Facility $2174.93 |
| East St. Louis | Office Unavailable | Facility $2266.03 |
| El Centro | Office Unavailable | Facility $1853.88 |
| Fort Lauderdale | Office Unavailable | Facility $2253.48 |
| Fort Worth | Office Unavailable | Facility $1893.83 |
| Fresno | Office Unavailable | Facility $1852.02 |
| Galveston | Office Unavailable | Facility $1881.76 |
| Hanford-Corcoran | Office Unavailable | Facility $1852.02 |
| Hawaii, Guam | Office Unavailable | Facility $1881.35 |
| Houston | Office Unavailable | Facility $2085.85 |
| Idaho | Office Unavailable | Facility $1692.13 |
| Indiana | Office Unavailable | Facility $1701.80 |
| Iowa | Office Unavailable | Facility $1660.37 |
| Kansas | Office Unavailable | Facility $1692.63 |
| Kentucky | Office Unavailable | Facility $1835.35 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $1980.87 |
| Madera | Office Unavailable | Facility $1852.02 |
| Manhattan | Office Unavailable | Facility $2330.02 |
| Merced | Office Unavailable | Facility $1852.02 |
| Metropolitan Boston | Office Unavailable | Facility $2072.63 |
| Metropolitan Kansas City | Office Unavailable | Facility $1892.94 |
| Metropolitan Philadelphia | Office Unavailable | Facility $2059.63 |
| Metropolitan St. Louis | Office Unavailable | Facility $1911.22 |
| Miami | Office Unavailable | Facility $2541.32 |
| Minnesota | Office Unavailable | Facility $1701.43 |
| Mississippi | Office Unavailable | Facility $1750.48 |
| Modesto | Office Unavailable | Facility $1852.02 |
| Montana** | Office Unavailable | Facility $1942.85 |
| Napa | Office Unavailable | Facility $2035.32 |
| Nebraska | Office Unavailable | Facility $1658.82 |
| Nevada** | Office Unavailable | Facility $1882.09 |
| New Hampshire | Office Unavailable | Facility $1925.34 |
| New Mexico | Office Unavailable | Facility $1961.18 |
| New Orleans | Office Unavailable | Facility $1953.53 |
| North Carolina | Office Unavailable | Facility $1762.92 |
| North Dakota** | Office Unavailable | Facility $1722.38 |
| Northern Nj | Office Unavailable | Facility $2134.84 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $2449.58 |
| Ohio | Office Unavailable | Facility $1886.54 |
| Oklahoma | Office Unavailable | Facility $1786.71 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $1953.46 |
| Portland | Office Unavailable | Facility $1938.95 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $2127.01 |
| Puerto Rico | Office Unavailable | Facility $1945.60 |
| Queens | Office Unavailable | Facility $2290.19 |
| Redding | Office Unavailable | Facility $1852.02 |
| Rest Of California | Office Unavailable | Facility $1852.02 |
| Rest Of Florida | Office Unavailable | Facility $2100.56 |
| Rest Of Georgia | Office Unavailable | Facility $1940.58 |
| Rest Of Illinois | Office Unavailable | Facility $2093.24 |
| Rest Of Louisiana | Office Unavailable | Facility $1848.60 |
| Rest Of Maine | Office Unavailable | Facility $1747.62 |
| Rest Of Maryland | Office Unavailable | Facility $1930.15 |
| Rest Of Massachusetts | Office Unavailable | Facility $1918.67 |
| Rest Of Michigan | Office Unavailable | Facility $1931.61 |
| Rest Of Missouri | Office Unavailable | Facility $1838.69 |
| Rest Of New Jersey | Office Unavailable | Facility $2078.45 |
| Rest Of New York | Office Unavailable | Facility $1798.49 |
| Rest Of Oregon | Office Unavailable | Facility $1830.23 |
| Rest Of Pennsylvania | Office Unavailable | Facility $1866.53 |
| Rest Of Texas | Office Unavailable | Facility $1872.28 |
| Rest Of Washington | Office Unavailable | Facility $1902.62 |
| Rhode Island | Office Unavailable | Facility $1942.89 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $1970.96 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $1915.00 |
| Salinas | Office Unavailable | Facility $1907.83 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $1934.72 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $2108.75 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $2096.09 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $2172.73 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $2120.96 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $1881.69 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $1937.66 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $1910.02 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $1954.56 |
| Seattle (King Cnty) | Office Unavailable | Facility $2076.15 |
| South Carolina | Office Unavailable | Facility $1835.29 |
| South Dakota** | Office Unavailable | Facility $1696.31 |
| Southern Maine | Office Unavailable | Facility $1799.96 |
| Stockton | Office Unavailable | Facility $1852.02 |
| Suburban Chicago | Office Unavailable | Facility $2255.91 |
| Tennessee | Office Unavailable | Facility $1708.37 |
| Utah | Office Unavailable | Facility $1864.21 |
| Vallejo | Office Unavailable | Facility $2017.07 |
| Vermont | Office Unavailable | Facility $1752.72 |
| Virgin Islands | Office Unavailable | Facility $1945.60 |
| Virginia | Office Unavailable | Facility $1822.38 |
| Visalia | Office Unavailable | Facility $1852.02 |
| West Virginia | Office Unavailable | Facility $2013.71 |
| Wisconsin | Office Unavailable | Facility $1656.90 |
| Wyoming** | Office Unavailable | Facility $1846.77 |
| Yuba City | Office Unavailable | Facility $1852.02 |
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22548 billing questions
How does this differ from 22595?
22548 describes anterior fusion of C1-C2 through a transoral or transpharyngeal route. 22595 describes posterior fusion of the atlas and axis.
Is odontoidectomy separately represented by this code?
Odontoidectomy, when performed as part of the transoral or transpharyngeal C1-C2 arthrodesis, is included in this code. Document whether it was performed and the clinical indication.
Can an assistant or co-surgeon be reported?
CMS permits assistant-at-surgery payment and co-surgeons for this service. Team surgery is not permitted.
Does modifier 50 apply?
No. This is a midline C1-C2 procedure, and bilateral adjustment is not appropriate.
How does the 90-day global period affect follow-up billing?
The day-before preoperative visit and 90 days of related postoperative care are included in the global period. Separately report only services that are distinct from included care under applicable coding rules.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,07922532,,Arthrd lat xtrcvtry tq thrc,A,,25.34,17.77,NA,17.77,,8.75,51.86,51.86,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08022533,,Arthrd lat xtrcvtry tq lmbr,A,,24.17,15.51,NA,15.51,,6.66,46.34,46.34,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08122534,,Arthrd lat xtrcvtry tq ea ad,A,,5.84,1.94,NA,1.94,,1.91,9.69,9.69,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08222548,,Arthrd ant toral/xoral c1-c2,A,,26.38,20.66,NA,20.66,,11.15,58.19,58.19,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08322551,,Arthrd ant ntrbdy cervical,A,,24.38,15.43,NA,15.43,,8.24,48.05,48.05,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08422552,,Arthrd ant ntrbd cervical ea,A,,6.34,2.13,NA,2.13,,2.10,10.57,10.57,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08522554,,Arthrd ant ntrbd min dsc crv,A,,17.25,13.35,NA,13.35,,5.80,36.40,36.40,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00