Billing code 22590: Posterior fusionMedicare rate & RVUs in Ohio
Reports posterior fusion across the craniocervical junction, typically stabilizing the occiput and upper cervical spine through C2.
CMS doesn’t publish an office rate for 22590 in Ohio.
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 22590 covers
This service fuses the junction between the skull base and upper cervical spine using a posterior surgical approach, generally spanning the occiput through C2. Neurosurgeons and orthopedic spine surgeons perform it in an operating room to stabilize craniocervical instability or deformity, including cases related to trauma or congenital conditions. The operative report should make the posterior approach and fused levels clear; it should also describe graft and fixation work performed.
CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate for this anatomy. Assistant-at-surgery and co-surgeon services may be paid; team surgery is not permitted. Report graft and instrumentation services separately when supported by the applicable coding requirements.
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.
22590 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | Unavailable | $1,510.71 |
How the 22590 rate is calculated
Each of 22590’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 · 22590
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 21.22Practice expense 17.41Malpractice 8.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 22590
22590 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 22590
Posterior 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) | 2 | Permitted. |
| 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 · 22590
Posterior 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
22590 without 51 · national facility
$1,559.15
Posterior fusion
22590-51 · Second procedure: 50%
$779.58
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%).
22590 compared with similar codes
Compare codes
22590 vs 22595 vs 22548 vs 22551: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 22595Cervical fusion
- Choose 22590 for posterior fusion spanning the craniocervical junction, generally occiput through C2; choose 22595 when the fusion is limited to C1-C2.
- 22548C1-C2 fusion
- 22548 describes an anterior transoral or extraoral approach for C1-C2 fusion. This code is for posterior craniocervical fusion.
- 22551ACDF
- 22551 is an anterior cervical interbody fusion code for subaxial cervical levels, not a posterior fusion across the skull base and upper cervical spine.
22590 billing questions
How is this code distinguished from 22595?
22590 describes posterior fusion across the craniocervical junction, generally occiput through C2. 22595 is for posterior fusion limited to the atlas and axis, C1-C2.
Can modifier 50 be used?
No. CMS identifies bilateral adjustment as inapplicable because the descriptor and anatomy make modifier 50 inappropriate.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
CMS permits payment for assistant-at-surgery and co-surgeon services for this code. Team surgery is not permitted.
How does the multiple-procedure rule affect payment?
For procedures performed in the same session, the highest-valued procedure is paid in full and other procedures are paid at 50%.
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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