Billing code 22840: Spinal fixationMedicare rate & RVUs in Guam
Reports posterior spinal fixation using a nonsegmental construct, typically as an add-on to a primary spinal procedure such as fusion.
CMS doesn’t publish an office rate for 22840 in Guam.
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 9 sections
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.
22840 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $633.97 |
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
Work12.21
12.21 RVUs× 1.000 GPCI
Practice expense4.04
4.04 RVUs× 1.000 GPCI
Malpractice3.76
3.76 RVUs× 1.000 GPCI
Adjusted RVUs
20.0100
Conversion factor
$33.4009
Medicare rate
$668.35
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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.
22840 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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