No office rate
22800 is the posterior deformity-fusion code for fewer than 6 vertebral segments; 22804 requires 13 or more.
On this page
CMS RVU26D · Effective 2026-10-01
22804 Spinal deformity fusion Medicare reimbursement rates in New Jersey
Posterior fusion of 13 or more vertebral segments to correct a spinal deformity, such as extensive scoliosis or kyphosis. Compare 22804 office and facility rates across CMS payment localities in New Jersey.
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 22804 in New Jersey?
New Jersey has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$2365.20–$2427.81
2 of 2 localities have a supported rate.
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 surgery
About 22804: Posterior spinal deformity fusion, 13 or more segments
Posterior fusion of 13 or more vertebral segments to correct a spinal deformity, such as extensive scoliosis or kyphosis.
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.
CMS billing rules for 22804
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care 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
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU36.56 · 55%
- Practice expense (office) RVU19.62 · 29%
- Malpractice RVU10.36 · 16%
264
Medicare services in 2024 · #4091 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.
22804 compared with similar codes
Office rates for New Jersey, from the same CMS release.
No office rate
22802 covers a posterior deformity fusion spanning 7 through 12 segments. The segment count must reach 13 for 22804.
No office rate
22812 describes anterior deformity fusion for 8 or more segments. Choose between it and 22804 based on the operative approach.
No office rate
22844 reports posterior segmental instrumentation for 13 or more segments, not the fusion itself; it may accompany 22804 when instrumentation is performed.
Compare 22804 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.
2 of 2 payment localities
Northern Nj →
Office / nonfacility
Unavailable
Facility
$2427.81
Rest Of New Jersey →
Office / nonfacility
Unavailable
Facility
$2365.20
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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 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.
2,09922634,,Arthrd cmbn 1ntrspc ea addl,A,,7.76,2.61,NA,2.61,,2.58,12.95,12.95,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10022800,,Arthrd pst dfrm<6 vrt sgm,A,,19.01,14.54,NA,14.54,,5.76,39.31,39.31,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10122802,,Arthrd pst dfrm 7-12 vrt sgm,A,,31.31,17.86,NA,17.86,,8.80,57.97,57.97,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10222804,,Arthrd pst dfrm 13+ vrt sgm,A,,36.56,19.62,NA,19.62,,10.36,66.54,66.54,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10322808,,Arthrd ant dfrm 2-3 vrt sgm,A,,26.82,17.22,NA,17.22,,8.49,52.53,52.53,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10422810,,Arthrd ant dfrm 4-7 vrt sgm,A,,30.71,16.51,NA,16.51,,6.55,53.77,53.77,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10522812,,Arthrd ant dfrm 8+ vrt sgm,A,,33.39,18.50,NA,18.50,,7.12,59.01,59.01,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00