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Billing code 22804: Spinal deformity fusionMedicare rate & RVUs

Posterior fusion of 13 or more vertebral segments to correct a spinal deformity, such as extensive scoliosis or kyphosis.

CMS RVU26DEffective Oct 1, 2026109 payment localities264 Medicare services in 2024

Medicare pays $2,222.50 for 22804 nationally in a facility.

Medicare rate · 22804

Spinal deformity fusion

Swap in your local Medicare rate.

Work RVUs
36.56
Total RVUs
66.54
Global days
090

National rate · 2026

$2,222.50

Facility setting, before claim adjustments.

See every locality for 22804 → · 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 22804 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 22804 covers

This code represents a posterior fusion spanning 13 or more vertebral segments to correct a spinal deformity, such as extensive scoliosis or kyphosis. An orthopedic spine surgeon or neurosurgeon typically performs the operation in a hospital operating room. The operative report should identify the posterior approach, the deformity being corrected, and the vertebral segments included in the fusion. Segment count is based on the vertebrae fused, not the number of screws or rods used.

Report this code when the documented posterior fusion reaches the 13-segment threshold; the shorter posterior deformity-fusion codes apply to smaller spans. Report spinal instrumentation separately when performed and supported by the operative details. The 90-day global includes the day-before preoperative visit and related care for 90 days after surgery. When multiple procedures occur in the same session, the highest-valued is paid in full and the others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeons require supporting documentation, and team surgery is not permitted.

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 22804 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

22804 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,990.40
Alaska*Unavailable$2,720.29
ArizonaUnavailable$2,152.35
ArkansasUnavailable$1,962.27
AtlantaUnavailable$2,306.20
AustinUnavailable$2,223.50
BakersfieldUnavailable$2,173.31
Baltimore/Surr. CntysUnavailable$2,371.88
BeaumontUnavailable$2,138.95
BrazoriaUnavailable$2,150.24

22804 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
22804 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 22804 rate is calculated

Each of 22804’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 · 22804

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 36.56Practice expense 19.62Malpractice 10.36

66.5400 adjusted RVUs×$33.4009 conversion factor=$2,222.50

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 22804

22804 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22804

Spinal deformity 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)1Permitted with supporting documentation.
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 · 22804

Spinal deformity 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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

22804 without 51 · national facility

$2,222.50

Spinal deformity fusion

22804-51 · Second procedure: 50%

$1,111.25

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

22804 compared with similar codes

Compare codes

22804 vs 22800 vs 22802 vs 22812 vs 22844: national Medicare rates

Swap in your local Medicare rate.

  • 22804
    Spinal deformity fusion · 36.56 wRVU
    —
  • 22800
    Spinal fusion · 19.01 wRVU
    —
  • 22802
    Spinal fusion · 31.31 wRVU
    —
  • 22812
    Anterior spinal fusion · 33.39 wRVU
    —
  • 22844
    Spinal fixation · 16.01 wRVU
    —

How to choose

22800Spinal fusion
22800 is the posterior deformity-fusion code for fewer than 6 vertebral segments; 22804 requires 13 or more.
22802Spinal fusion
22802 covers a posterior deformity fusion spanning 7 through 12 segments. The segment count must reach 13 for 22804.
22812Anterior spinal fusion
22812 describes anterior deformity fusion for 8 or more segments. Choose between it and 22804 based on the operative approach.
22844Spinal fixation
22844 reports posterior segmental instrumentation for 13 or more segments, not the fusion itself; it may accompany 22804 when instrumentation is performed.

Codes related to 22804

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

Codes related to 22804
CodeHow it relatesNational office range
Same family
22800Spinal fusionPosterior deformity fusion for fewer than 6 vertebral segments.No office rate
22802Spinal fusionPosterior deformity fusion for 7 through 12 vertebral segments.No office rate
Used instead
22812Anterior spinal fusionAnterior deformity fusion for 8 or more segments, rather than a posterior approach.No office rate
Often billed with
22844Spinal fixationPosterior segmental instrumentation for 13 or more segments when instrumentation is performed.No office rate

22804 billing questions

How is 22804 distinguished from 22802?

Use 22804 for posterior deformity fusion of 13 or more vertebral segments. Use 22802 when the posterior fusion spans 7 through 12 segments.

Does the fusion code include spinal instrumentation?

Instrumentation is reported separately when it is performed and supported by the operative documentation. For a posterior construct spanning 13 or more segments, 22844 may describe the instrumentation.

What documentation supports the segment count?

The operative report should state the posterior approach and identify the vertebral segments included in the fusion. Count the fused vertebral segments, not the implanted screws or rods.

How does the multiple-procedure rule affect payment?

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

Can an assistant or co-surgeon be reported?

Assistant-at-surgery payment may be available. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.

What care is included in the global period?

The 90-day global includes the day-before preoperative visit and related postoperative care for 90 days after surgery.

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 22804PPRRVU2026_Oct_nonQPP.csv, line 2,102 (RVU26D)

Open CMS sourceHow we calculate rates

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