Billing code 22846: Spinal fixationMedicare rate & RVUs in Oregon
Reports anterior spinal fixation spanning four to seven vertebral segments, typically added to a qualifying fusion or other primary spinal procedure.
CMS doesn’t publish an office rate for 22846 in Oregon.
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 22846 covers
This code represents an anteriorly placed fixation construct spanning four to seven vertebral segments. A spine surgeon may use a plate-and-screw construct to stabilize the spine during an anterior fusion, such as multilevel cervical fusion, or another qualifying spinal operation. The construct’s approach and span distinguish this service from posterior fixation and from a device placed within an interspace.
Select the code by counting the vertebral segments instrumented, not the number of screws or the number of disc spaces treated. The operative report should identify the anterior approach and the segments spanned by the fixation construct. This is an add-on code: report it only with a qualifying primary procedure, not by itself. CMS payment is tied to the primary procedure’s global period.
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 22846 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $660.59 |
| Rest Of Oregon | Unavailable | $633.04 |
How the 22846 rate is calculated
Each of 22846’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 · 22846
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 12.09Practice expense 4.06Malpractice 4.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 22846
The CMS indicators that decide how 22846 is paid alongside other services.
CMS payment indicators · 22846
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) | 2 | Permitted. |
| 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
22846 without 80 · national facility
$673.36
Spinal fixation
22846-80 · Assistant: 16%
$107.74
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
22846 compared with similar codes
Compare codes
22846 vs 22845 vs 22847 vs 22842 vs 22853: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 22845Anterior fixation
- Both describe anterior fixation, but 22845 is for two to three vertebral segments; 22846 is for four to seven.
- 22847Spinal fixation
- Both describe anterior fixation, but 22847 is for eight or more vertebral segments; 22846 is for four to seven.
- 22842Spinal fixation
- 22842 describes posterior fixation across three to six vertebral segments. Use the approach documented in the operative report to distinguish it from anterior fixation.
- 22853Interbody device
- 22853 describes placement of an interbody biomechanical device within an interspace. It is distinct from the anterior fixation construct represented by 22846.
22846 billing questions
How is 22846 distinguished from 22845 and 22847?
Choose by the number of vertebral segments spanned by the anterior construct: 22846 covers four to seven. Codes 22845 and 22847 cover smaller and larger spans, respectively.
Do I count treated disc spaces or fixation hardware?
Base selection on the vertebral segments instrumented. The number of screws and the number of disc spaces treated do not set the code level.
Can 22846 be billed by itself?
No. It is an add-on code and must be reported with a qualifying primary procedure.
What should the operative report document?
Document the anterior approach and the vertebral segments spanned by the fixation construct. This supports both the instrumentation type and the four-to-seven-segment selection.
Is an interbody device the same service as 22846?
No. 22846 represents anterior fixation spanning vertebral segments; an interbody device is placed within a disc space. The operative report should support each service reported.
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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