Billing code 22804: Spinal deformity fusionMedicare rate & RVUs in Missouri
Posterior fusion of 13 or more vertebral segments to correct a spinal deformity, such as extensive scoliosis or kyphosis.
CMS doesn’t publish an office rate for 22804 in Missouri.
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 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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | Unavailable | $2,174.56 |
| Metropolitan St. Louis | Unavailable | $2,191.73 |
| Rest Of Missouri | Unavailable | $2,123.06 |
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
Work36.56
36.56 RVUs× 1.000 GPCI
Practice expense19.62
19.62 RVUs× 1.000 GPCI
Malpractice10.36
10.36 RVUs× 1.000 GPCI
Adjusted RVUs
66.5400
Conversion factor
$33.4009
Medicare rate
$2,222.50
Every GPCI starts 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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%).
22804 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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