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Billing code 22590: Posterior fusionMedicare rate & RVUs

Reports posterior fusion across the craniocervical junction, typically stabilizing the occiput and upper cervical spine through C2.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.1K Medicare services in 2024

Medicare pays $1,559.15 for 22590 nationally in a facility.

Medicare rate · 22590

Posterior fusion

Work RVUs
21.22
Total RVUs
46.68
Global days
090

National rate · 2026

$1,559.15

Facility setting, before claim adjustments.

See every locality for 22590 →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.

On this page 10 sections
  1. Medicare rate
  2. What 22590 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 22590 covers

This service fuses the junction between the skull base and upper cervical spine using a posterior surgical approach, generally spanning the occiput through C2. Neurosurgeons and orthopedic spine surgeons perform it in an operating room to stabilize craniocervical instability or deformity, including cases related to trauma or congenital conditions. The operative report should make the posterior approach and fused levels clear; it should also describe graft and fixation work performed.

CMS 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 the others at 50%. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery and co-surgeon services may be paid; team surgery is not permitted. Report graft and instrumentation services separately when supported by the applicable coding requirements.

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 22590 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

22590 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,369.77
Alaska*Unavailable$1,830.61
ArizonaUnavailable$1,502.41
ArkansasUnavailable$1,346.76
AtlantaUnavailable$1,624.63
AustinUnavailable$1,563.65
BakersfieldUnavailable$1,523.31
Baltimore/Surr. CntysUnavailable$1,676.67
BeaumontUnavailable$1,487.73
BrazoriaUnavailable$1,500.44

22590 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
22590 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 22590 rate is calculated

Each of 22590’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 · 22590

RVUs × geographic indexes × conversion factor

Work21.22

21.22 RVUs× 1.000 GPCI

Practice expense17.41

17.41 RVUs× 1.000 GPCI

Malpractice8.05

8.05 RVUs× 1.000 GPCI

Adjusted RVUs

46.6800

Conversion factor

$33.4009

Medicare rate

$1,559.15

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

Payment rules and modifiers for 22590

22590 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22590

Posterior fusion

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)0Not permitted.
Professional/technical0Physician service: no professional/technical split.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 22590

Posterior fusion

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

22590 without 51 · national facility

$1,559.15

Posterior fusion

22590-51 · Second procedure: 50%

$779.58

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

22590 compared with similar codes

Compare codes · National

4 codes, side by side

  • 22590

    Posterior fusion21.22 wRVU

    Not priced

  • 22595

    Cervical fusion20.12 wRVU

    Not priced

  • 22548

    C1-C2 fusion26.38 wRVU

    Not priced

  • 22551

    ACDF24.38 wRVU

    Not priced

How to choose

22595Cervical fusion
Choose 22590 for posterior fusion spanning the craniocervical junction, generally occiput through C2; choose 22595 when the fusion is limited to C1-C2.
22548C1-C2 fusion
22548 describes an anterior transoral or extraoral approach for C1-C2 fusion. This code is for posterior craniocervical fusion.
22551ACDF
22551 is an anterior cervical interbody fusion code for subaxial cervical levels, not a posterior fusion across the skull base and upper cervical spine.

Codes related to 22590

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

Codes related to 22590
CodeHow it relatesNational office range
Same family
22595Cervical fusionPosterior fusion of C1-C2, a narrower upper-cervical level.No office rate
Used instead
22548C1-C2 fusionUses an anterior transoral or extraoral approach for C1-C2 fusion.No office rate
Add-on codes
20930Sp bone algrft morsel add-onMorselized allograft add-on that may accompany spinal arthrodesis.No office rate
20936Sp bone agrft local add-onLocal autograft add-on that may accompany spinal arthrodesis.No office rate
Often billed with
22840Spinal fixationPosterior nonsegmental instrumentation may be reported with the fusion when performed.No office rate

22590 billing questions

How is this code distinguished from 22595?

22590 describes posterior fusion across the craniocervical junction, generally occiput through C2. 22595 is for posterior fusion limited to the atlas and axis, C1-C2.

Can modifier 50 be used?

No. CMS identifies bilateral adjustment as inapplicable because the descriptor and anatomy make modifier 50 inappropriate.

What 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?

CMS permits payment for assistant-at-surgery and co-surgeon services for this code. Team surgery is not permitted.

How does the multiple-procedure rule affect payment?

For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%.

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 22590PPRRVU2026_Oct_nonQPP.csv, line 2,090 (RVU26D)

Open CMS sourceHow we calculate rates

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