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Billing code 22840: Spinal fixationMedicare rate & RVUs

Reports posterior spinal fixation using a nonsegmental construct, typically as an add-on to a primary spinal procedure such as fusion.

CMS RVU26DEffective Oct 1, 2026109 payment localities59.7K Medicare services in 2024

Medicare pays $668.35 for 22840 nationally in a facility.

Medicare rate · 22840

Spinal fixation

Swap in your local Medicare rate.

Work RVUs
12.21
Total RVUs
20.01
Global days
ZZZ

National rate · 2026

$668.35

Facility setting, before claim adjustments.

See every locality for 22840 → · 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 22840 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 22840 covers

This add-on represents posterior fixation that stabilizes the spine without segmental attachment at each vertebral level, such as a construct spanning one interspace. It may be used during instrumented spinal fusion or another primary spine operation when posterior stabilization is performed. Orthopedic spine surgeons and neurosurgeons commonly place this hardware in an operating room, including for cases involving spinal instability or deformity.

Report 22840 with the primary procedure performed in the same operative session; it is not a standalone service. The operative report should identify the posterior fixation method, the vertebral levels or interspace spanned, and how the construct differs from segmental fixation. CMS treats this as an add-on code: payment is made within the primary procedure’s global period. The segmental extent and fixation pattern help distinguish it from codes for longer posterior segmental constructs.

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 22840 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

22840 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$596.98
Alaska*Unavailable$824.65
ArizonaUnavailable$646.08
ArkansasUnavailable$588.42
AtlantaUnavailable$696.98
AustinUnavailable$662.68
BakersfieldUnavailable$639.95
Baltimore/Surr. CntysUnavailable$714.49
BeaumontUnavailable$647.29
BrazoriaUnavailable$642.77

22840 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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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
22840 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 22840 rate is calculated

Each of 22840’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 · 22840

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 12.21Practice expense 4.04Malpractice 3.76

20.0100 adjusted RVUs×$33.4009 conversion factor=$668.35

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

Payment rules and modifiers for 22840

The CMS indicators that decide how 22840 is paid alongside other services.

CMS payment indicators · 22840

Spinal fixation

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
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.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

22840 without 80 · national facility

$668.35

Spinal fixation

22840-80 · Assistant: 16%

$106.94

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

22840 compared with similar codes

Compare codes

22840 vs 22842 vs 22841 vs 22845 vs 22853: national Medicare rates

Swap in your local Medicare rate.

  • 22840
    Spinal fixation · 12.21 wRVU
    —
  • 22842
    Spinal fixation · 12.25 wRVU
    —
  • 22841
    · 0 wRVU
    —
  • 22845
    Anterior fixation · 11.64 wRVU
    —
  • 22853
    Interbody device · 4.14 wRVU
    —

How to choose

22842Spinal fixation
Use 22840 for posterior nonsegmental fixation; 22842 describes segmental posterior instrumentation across 3 to 6 vertebral segments.
22841Insert spine fixation device
22841 describes internal fixation by wiring spinous processes, while 22840 covers a nonsegmental posterior fixation construct.
22845Anterior fixation
22845 describes anterior instrumentation across 2 to 3 vertebral segments. Choose based on the approach and instrumentation performed, not simply the number of levels fused.
22853Interbody device
22853 covers placement of an interbody biomechanical device; 22840 covers posterior spinal fixation. Both may be relevant when both services are performed.

Codes related to 22840

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

Codes related to 22840
CodeHow it relatesNational office range
Same family
22842Spinal fixationPosterior segmental fixation across 3 to 6 vertebral segments.No office rate
22843Spinal fixationPosterior segmental fixation across 7 to 12 vertebral segments.No office rate
22844Spinal fixationPosterior segmental fixation across 13 or more vertebral segments.No office rate
Used instead
22841Insert spine fixation deviceDescribes posterior internal fixation by wiring spinous processes.No office rate
Often billed with
22612Spinal fusionPosterior lumbar fusion is a common primary procedure for an instrumented case.No office rate
22853Interbody deviceMay accompany posterior fixation when an interbody biomechanical device is also placed.No office rate

22840 billing questions

How is 22840 distinguished from 22842?

22840 describes posterior nonsegmental fixation, such as a construct spanning one interspace. 22842 is for posterior segmental instrumentation across 3 to 6 vertebral segments.

Can 22840 be billed by itself?

No. It is an add-on code and must be reported with a primary procedure performed in the operative session.

Does 22840 include an interbody cage?

No. Posterior fixation and an interbody biomechanical device are different services. Code 22853 may be relevant when an interbody device is also placed.

What should the operative report document?

Document the posterior fixation method, the vertebral levels or interspace spanned, and whether fixation is nonsegmental rather than attached segmentally across multiple levels.

How does the add-on status affect Medicare payment?

CMS pays 22840 within the global period of the primary procedure. Report it only with that primary procedure.

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 22840PPRRVU2026_Oct_nonQPP.csv, line 2,112 (RVU26D)

Open CMS sourceHow we calculate rates

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