$29.92
Use 98925 for osteopathic manipulative treatment involving one or two regions. Code 22505 describes spinal manipulation performed with anesthesia.
On this page
CMS RVU26D · Effective 2026-10-01
22505 Spinal manipulation Medicare reimbursement rates in Alabama
Reports spinal manipulation performed with anesthesia, for a documented condition affecting any spinal region, in settings such as a hospital outpatient department or ASC. Compare 22505 office and facility rates across CMS payment localities in Alabama.
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 22505 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$133.99
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
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.
Spinal procedures
About 22505: Spinal manipulation under anesthesia
Reports spinal manipulation performed with anesthesia, for a documented condition affecting any spinal region, in settings such as a hospital outpatient department or ASC.
Code 22505 represents a clinician’s manipulation of the spine while the patient is under anesthesia. The code can apply to manipulation involving the cervical, thoracic, or lumbar region; selection is not based on a region-specific code level. It is distinct from routine hands-on spinal treatment performed while the patient is awake. The service is commonly furnished in a facility setting, such as a hospital outpatient department or ambulatory surgical center.
Report the service when the record supports the spinal condition, the region treated, the manipulation performed, and the use of anesthesia. Related postoperative visits during the 10-day global period are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Do not use modifier 50 for bilateral reporting. Medicare does not pay an assistant at surgery for this code, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 22505
- Global period
- Minor procedure with a 10-day global period: related postoperative visits for 10 days 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
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.82 · 40%
- Practice expense (office) RVU2.00 · 43%
- Malpractice RVU0.78 · 17%
86
Medicare services in 2024 · #4989 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.
22505 compared with similar codes
Office rates for Alabama, from the same CMS release.
$80.32
Use 98929 for osteopathic manipulative treatment involving five regions. The count of regions distinguishes it from 22505, which is selected for manipulation under anesthesia.
$25.95
Use 97140 for timed manual therapy techniques. It does not describe spinal manipulation performed with anesthesia.
Compare 22505 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.
1 of 1 payment localities
Alabama →
Office / nonfacility
Unavailable
Facility
$133.99
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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 22505 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
2,070
- Code
- 22505
- Physician work
- 1.82
- Practice expense
- 2.00
- Malpractice
- 0.78
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.82 | × 1.000 | 1.8200 |
| Practice expense | 2.00 | × 0.875 | 1.7500 |
| Malpractice | 0.78 | × 0.566 | 0.4415 |
| Total RVUs | 4.0115 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Alabama$133.99
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.82 | 1 |
| Practice expense | 2 | 0.875 |
| Malpractice | 0.78 | 0.566 |
(1.82 × 1 + 2 × 0.875 + 0.78 × 0.566) × $33.4009 = $133.99
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.
22505 billing questions
How is 22505 different from office-based spinal manipulation?
22505 is for spinal manipulation performed with anesthesia. Routine osteopathic manipulative treatment or manual therapy without anesthesia is reported under the code that describes that service.
What documentation supports reporting 22505?
Document the spinal condition, the region treated, the manipulation performed, and that anesthesia was used. The record should make clear that this was not routine awake manual treatment.
Can modifier 50 be used when more than one side is treated?
No. CMS identifies bilateral adjustment as inappropriate for this code, so do not append modifier 50.
Are postoperative visits separately reportable?
Related postoperative visits during the 10-day global period are included in the procedure.
How does payment work if other procedures are performed in the same session?
The highest-valued procedure is paid in full, and other procedures are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery for 22505; co-surgeons and team surgery are not permitted.
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.
2,06722326,,Treat neck spine fracture,A,,20.32,16.37,NA,16.37,,7.43,44.12,44.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,06822327,,Treat thorax spine fracture,A,,20.25,17.55,NA,17.55,,7.21,45.01,45.01,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,06922328,,Treat each add spine fx,A,,4.49,1.51,NA,1.51,,1.56,7.56,7.56,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,07022505,,Manipulation of spine,A,,1.82,2.00,NA,2.00,,0.78,4.60,4.60,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,07122510,,Perq cervicothoracic inject,A,,7.70,43.93,,2.61,,1.16,52.79,11.47,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,07222511,,Perq lumbosacral injection,A,,7.15,44.89,,2.60,,1.07,53.11,10.82,0,010,0.10,0.80,0.10,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,07322512,,Vertebroplasty addl inject,A,,3.90,17.53,,0.81,,0.72,22.15,5.43,0,ZZZ,0.00,0.00,0.00,0,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515