No office rate
Both describe anterior fixation, but 22845 is for two to three vertebral segments; 22846 is for four to seven.
On this page
CMS RVU26D · Effective 2026-10-01
22846 in Modesto
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$631.10
Base rate per service
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.
Spinal instrumentation
About 22846: Anterior spinal fixation, four to seven segments
Reports anterior spinal fixation spanning four to seven vertebral segments, typically added to a qualifying fusion or other primary spinal procedure.
This code represents an anteriorly placed fixation construct spanning four to seven vertebral segments. A spine surgeon may use a plate-and-screw construct to stabilize the spine during an anterior fusion, such as multilevel cervical fusion, or another qualifying spinal operation. The construct’s approach and span distinguish this service from posterior fixation and from a device placed within an interspace.
Select the code by counting the vertebral segments instrumented, not the number of screws or the number of disc spaces treated. The operative report should identify the anterior approach and the segments spanned by the fixation construct. This is an add-on code: report it only with a qualifying primary procedure, not by itself. CMS payment is tied to the primary procedure’s global period.
CMS billing rules for 22846
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU12.09 · 60%
- Practice expense (office) RVU4.06 · 20%
- Malpractice RVU4.01 · 20%
13.3K
Medicare services in 2024 · #1324 by national volume
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.
22846 compared with similar codes
Office rates for Modesto, from the same CMS release.
No office rate
Both describe anterior fixation, but 22847 is for eight or more vertebral segments; 22846 is for four to seven.
No office rate
22842 describes posterior fixation across three to six vertebral segments. Use the approach documented in the operative report to distinguish it from anterior fixation.
No office rate
22853 describes placement of an interbody biomechanical device within an interspace. It is distinct from the anterior fixation construct represented by 22846.
The same code, a different location
How does Modesto compare?
22846 across payment areas
Same release and payment basis · bars start at $0
Modesto · This locality
Unavailable
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
No comparable rate is available in this setting.
Other payment areas listed in California appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Madera
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Merced
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Napa
California · 22846
Office
Unavailable
Facility
$676.03
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 22846
Office
Unavailable
Facility
$658.86
No comparable office rate is available.
Redding
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Rest Of California
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 22846
Office
Unavailable
Facility
$673.96
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 22846
Office
Unavailable
Facility
$647.86
No comparable office rate is available.
Salinas
California · 22846
Office
Unavailable
Facility
$645.30
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 22846
Office
Unavailable
Facility
$650.71
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 22846
Office
Unavailable
Facility
$694.86
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 22846
Office
Unavailable
Facility
$690.31
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 22846
Office
Unavailable
Facility
$715.57
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 22846
Office
Unavailable
Facility
$696.96
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 22846
Office
Unavailable
Facility
$636.93
No comparable office rate is available.
Santa Cruz-Watsonville
California · 22846
Office
Unavailable
Facility
$648.85
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 22846
Office
Unavailable
Facility
$645.03
No comparable office rate is available.
Santa Rosa-Petaluma
California · 22846
Office
Unavailable
Facility
$654.25
No comparable office rate is available.
Stockton
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Vallejo
California · 22846
Office
Unavailable
Facility
$669.47
No comparable office rate is available.
Visalia
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Yuba City
California · 22846
Office
Unavailable
Facility
$631.10
No comparable office rate is available.
Dc + Md/Va Suburbs
District of Columbia · 22846
Office
Unavailable
Facility
$734.44
No comparable office rate is available.
Miami
Florida · 22846
Office
Unavailable
Facility
$883.71
No comparable office rate is available.
Chicago
Illinois · 22846
Office
Unavailable
Facility
$850.32
No comparable office rate is available.
Manhattan
New York · 22846
Office
Unavailable
Facility
$799.66
No comparable office rate is available.
Alaska*
Alaska · 22846
Office
Unavailable
Facility
$823.95
No comparable office rate is available.
Alabama
Alabama · 22846
Office
Unavailable
Facility
$598.28
No comparable office rate is available.
Arkansas
Arkansas · 22846
Office
Unavailable
Facility
$589.28
No comparable office rate is available.
Arizona
Arizona · 22846
Office
Unavailable
Facility
$649.87
No comparable office rate is available.
Colorado
Colorado · 22846
Office
Unavailable
Facility
$657.55
No comparable office rate is available.
Connecticut
Connecticut · 22846
Office
Unavailable
Facility
$720.01
No comparable office rate is available.
Delaware
Delaware · 22846
Office
Unavailable
Facility
$660.23
No comparable office rate is available.
Fort Lauderdale
Florida · 22846
Office
Unavailable
Facility
$783.35
No comparable office rate is available.
Rest Of Florida
Florida · 22846
Office
Unavailable
Facility
$734.77
No comparable office rate is available.
Atlanta
Georgia · 22846
Office
Unavailable
Facility
$703.66
No comparable office rate is available.
Rest Of Georgia
Georgia · 22846
Office
Unavailable
Facility
$684.43
No comparable office rate is available.
Hawaii, Guam
Hawaii · 22846
Office
Unavailable
Facility
$635.55
No comparable office rate is available.
Iowa
Iowa · 22846
Office
Unavailable
Facility
$581.07
No comparable office rate is available.
Idaho
Idaho · 22846
Office
Unavailable
Facility
$591.93
No comparable office rate is available.
East St. Louis
Illinois · 22846
Office
Unavailable
Facility
$798.33
No comparable office rate is available.
Rest Of Illinois
Illinois · 22846
Office
Unavailable
Facility
$736.97
No comparable office rate is available.
Suburban Chicago
Illinois · 22846
Office
Unavailable
Facility
$783.25
No comparable office rate is available.
Indiana
Indiana · 22846
Office
Unavailable
Facility
$594.62
No comparable office rate is available.
Kansas
Kansas · 22846
Office
Unavailable
Facility
$593.91
No comparable office rate is available.
Kentucky
Kentucky · 22846
Office
Unavailable
Facility
$646.92
No comparable office rate is available.
New Orleans
Louisiana · 22846
Office
Unavailable
Facility
$683.58
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 22846
Office
Unavailable
Facility
$652.14
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 22846
Office
Unavailable
Facility
$701.49
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 22846
Office
Unavailable
Facility
$659.82
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 22846
Office
Unavailable
Facility
$721.47
No comparable office rate is available.
Rest Of Maryland
Maryland · 22846
Office
Unavailable
Facility
$668.04
No comparable office rate is available.
Rest Of Maine
Maine · 22846
Office
Unavailable
Facility
$611.89
No comparable office rate is available.
Southern Maine
Maine · 22846
Office
Unavailable
Facility
$622.72
No comparable office rate is available.
Detroit
Michigan · 22846
Office
Unavailable
Facility
$760.50
No comparable office rate is available.
Rest Of Michigan
Michigan · 22846
Office
Unavailable
Facility
$678.84
No comparable office rate is available.
Minnesota
Minnesota · 22846
Office
Unavailable
Facility
$583.00
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 22846
Office
Unavailable
Facility
$662.01
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 22846
Office
Unavailable
Facility
$667.12
No comparable office rate is available.
Rest Of Missouri
Missouri · 22846
Office
Unavailable
Facility
$651.17
No comparable office rate is available.
Mississippi
Mississippi · 22846
Office
Unavailable
Facility
$619.55
No comparable office rate is available.
Montana**
Montana · 22846
Office
Unavailable
Facility
$673.09
No comparable office rate is available.
North Carolina
North Carolina · 22846
Office
Unavailable
Facility
$615.92
No comparable office rate is available.
North Dakota**
North Dakota · 22846
Office
Unavailable
Facility
$593.80
No comparable office rate is available.
Nebraska
Nebraska · 22846
Office
Unavailable
Facility
$579.61
No comparable office rate is available.
New Hampshire
New Hampshire · 22846
Office
Unavailable
Facility
$662.18
No comparable office rate is available.
Northern Nj
New Jersey · 22846
Office
Unavailable
Facility
$729.61
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 22846
Office
Unavailable
Facility
$714.98
No comparable office rate is available.
New Mexico
New Mexico · 22846
Office
Unavailable
Facility
$689.03
No comparable office rate is available.
Nevada**
Nevada · 22846
Office
Unavailable
Facility
$651.13
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 22846
Office
Unavailable
Facility
$839.62
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 22846
Office
Unavailable
Facility
$732.54
No comparable office rate is available.
Queens
New York · 22846
Office
Unavailable
Facility
$783.09
No comparable office rate is available.
Rest Of New York
New York · 22846
Office
Unavailable
Facility
$626.80
No comparable office rate is available.
Ohio
Ohio · 22846
Office
Unavailable
Facility
$662.64
No comparable office rate is available.
Oklahoma
Oklahoma · 22846
Office
Unavailable
Facility
$628.98
No comparable office rate is available.
Portland
Oregon · 22846
Office
Unavailable
Facility
$660.59
No comparable office rate is available.
Rest Of Oregon
Oregon · 22846
Office
Unavailable
Facility
$633.04
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 22846
Office
Unavailable
Facility
$712.04
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 22846
Office
Unavailable
Facility
$654.88
No comparable office rate is available.
Puerto Rico
Puerto Rico · 22846
Office
Unavailable
Facility
$672.84
No comparable office rate is available.
Rhode Island
Rhode Island · 22846
Office
Unavailable
Facility
$671.04
No comparable office rate is available.
South Carolina
South Carolina · 22846
Office
Unavailable
Facility
$642.97
No comparable office rate is available.
South Dakota**
South Dakota · 22846
Office
Unavailable
Facility
$584.43
No comparable office rate is available.
Tennessee
Tennessee · 22846
Office
Unavailable
Facility
$599.01
No comparable office rate is available.
Austin
Texas · 22846
Office
Unavailable
Facility
$666.77
No comparable office rate is available.
Beaumont
Texas · 22846
Office
Unavailable
Facility
$651.65
No comparable office rate is available.
Brazoria
Texas · 22846
Office
Unavailable
Facility
$645.91
No comparable office rate is available.
Dallas
Texas · 22846
Office
Unavailable
Facility
$657.43
No comparable office rate is available.
Fort Worth
Texas · 22846
Office
Unavailable
Facility
$657.82
No comparable office rate is available.
Galveston
Texas · 22846
Office
Unavailable
Facility
$652.61
No comparable office rate is available.
Houston
Texas · 22846
Office
Unavailable
Facility
$726.00
No comparable office rate is available.
Rest Of Texas
Texas · 22846
Office
Unavailable
Facility
$653.45
No comparable office rate is available.
Utah
Utah · 22846
Office
Unavailable
Facility
$651.56
No comparable office rate is available.
Virginia
Virginia · 22846
Office
Unavailable
Facility
$631.68
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 22846
Office
Unavailable
Facility
$672.84
No comparable office rate is available.
Vermont
Vermont · 22846
Office
Unavailable
Facility
$605.84
No comparable office rate is available.
Rest Of Washington
Washington · 22846
Office
Unavailable
Facility
$653.79
No comparable office rate is available.
Seattle (King Cnty)
Washington · 22846
Office
Unavailable
Facility
$699.83
No comparable office rate is available.
Wisconsin
Wisconsin · 22846
Office
Unavailable
Facility
$574.98
No comparable office rate is available.
West Virginia
West Virginia · 22846
Office
Unavailable
Facility
$713.32
No comparable office rate is available.
Wyoming**
Wyoming · 22846
Office
Unavailable
Facility
$638.54
No comparable office rate is available.
See how rates vary across the country
22846 · 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 |
Where does this rate apply?
Modesto is a Medicare payment area. Our Census mapping connects it to 33 cities and communities in California, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 22846 in Modesto. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$694.21
$631.10 × 110% = $694.21
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 22846 in Modesto.
PPRRVU2026_Oct_nonQPP.csv
2,118
- Code
- 22846
- Physician work
- 12.09
- Practice expense
- 4.06
- Malpractice
- 4.01
GPCI2026.csv
16
- Locality
- Modesto
- Physician work
- 1.017
- Practice expense
- 1.096
- Malpractice
- 0.536
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 12.09 | × 1.017 | 12.2955 |
| Practice expense | 4.06 | × 1.096 | 4.4498 |
| Malpractice | 4.01 | × 0.536 | 2.1494 |
| Total RVUs | 18.8946 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Modesto$631.10
Open 22846 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 12.09 | 1.017 |
| Practice expense | 4.06 | 1.096 |
| Malpractice | 4.01 | 0.536 |
(12.09 × 1.017 + 4.06 × 1.096 + 4.01 × 0.536) × $33.4009 = $631.10
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
22846 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $631.10 | RVU26D |
| 2026-07-01 | Not available in this setting | $631.10 | RVU26C |
| 2026-04-01 | Not available in this setting | $631.10 | RVU26B |
| 2026-01-01 | Not available in this setting | $631.10 | RVU26A |
| 2025-10-01 | Not available in this setting | $701.74 | RVU25D |
| 2025-07-01 | Not available in this setting | $701.74 | RVU25C |
| 2025-04-01 | Not available in this setting | $701.74 | RVU25B |
| 2025-01-01 | Not available in this setting | $701.74 | RVU25A |
22846 billing questions
How is 22846 distinguished from 22845 and 22847?
Choose by the number of vertebral segments spanned by the anterior construct: 22846 covers four to seven. Codes 22845 and 22847 cover smaller and larger spans, respectively.
Do I count treated disc spaces or fixation hardware?
Base selection on the vertebral segments instrumented. The number of screws and the number of disc spaces treated do not set the code level.
Can 22846 be billed by itself?
No. It is an add-on code and must be reported with a qualifying primary procedure.
What should the operative report document?
Document the anterior approach and the vertebral segments spanned by the fixation construct. This supports both the instrumentation type and the four-to-seven-segment selection.
Is an interbody device the same service as 22846?
No. 22846 represents anterior fixation spanning vertebral segments; an interbody device is placed within a disc space. The operative report should support each service reported.
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.
2,11522843,,Insert spine fixation device,A,,13.10,4.40,NA,4.40,,4.31,21.81,21.81,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11622844,,Insert spine fixation device,A,,16.01,5.32,NA,5.32,,4.87,26.20,26.20,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11722845,,Insert spine fixation device,A,,11.64,3.90,NA,3.90,,3.85,19.39,19.39,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11822846,,Insert spine fixation device,A,,12.09,4.06,NA,4.06,,4.01,20.16,20.16,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11922847,,Insert spine fixation device,A,,13.44,4.28,NA,4.28,,2.86,20.58,20.58,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12022848,,Insert pelv fixation device,A,,5.84,1.93,NA,1.93,,1.74,9.51,9.51,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12122849,,Reinsert spinal fixation,A,,18.69,12.26,NA,12.26,,5.78,36.73,36.73,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1301182,CA,18,LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY),1.041,1.183,0.664
1401112,CA,58,MADERA,1.017,1.096,0.536
1501112,CA,59,MERCED,1.017,1.096,0.536
1601112,CA,60,MODESTO,1.017,1.096,0.536
1701112,CA,51,NAPA,1.063,1.318,0.508
1801182,CA,17,OXNARD-THOUSAND OAKS-VENTURA,1.028,1.182,0.623
1901112,CA,61,REDDING,1.017,1.096,0.536