Billing code 22845: Anterior fixationMedicare rate & RVUs in Pennsylvania
Reports anterior spinal fixation spanning two or three vertebral segments during a qualifying spine operation, such as fusion with an anterior plate.
CMS doesn’t publish an office rate for 22845 in Pennsylvania.
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 22845 covers
22845 reports placement of anterior spinal fixation across two or three vertebral segments as part of a spine operation. A common example is an anterior cervical plate secured with screws across the operative vertebrae during cervical fusion; anterior fixation may also be used with thoracic or lumbar procedures. The work is typically performed by an orthopedic spine surgeon or neurosurgeon in an operating room. This code represents supplemental stabilization, not an interbody cage or the fusion itself.
Select the code based on the vertebral segments actually instrumented, not simply the number of disc spaces treated. The operative report should identify the anterior approach, device placement, segments spanned, and associated primary procedure. 22845 is an add-on code: report it only with an eligible primary procedure, and Medicare payment is handled within that procedure’s global period. It is not a standalone service. For fixation spanning more segments, use the applicable higher segment-count code when supported by the operative details.
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 22845 pays more and less in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia | Unavailable | $684.80 |
| Rest Of Pennsylvania | Unavailable | $629.89 |
How the 22845 rate is calculated
Each of 22845’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 · 22845
RVUs × geographic indexes × conversion factor
Work11.64
11.64 RVUs× 1.000 GPCI
Practice expense3.90
3.90 RVUs× 1.000 GPCI
Malpractice3.85
3.85 RVUs× 1.000 GPCI
Adjusted RVUs
19.3900
Conversion factor
$33.4009
Medicare rate
$647.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 22845
The CMS indicators that decide how 22845 is paid alongside other services.
CMS payment indicators · 22845
Anterior 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
22845 without 80 · national facility
$647.64
Anterior fixation
22845-80 · Assistant: 16%
$103.62
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
22845 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 22846Spinal fixation
- Both describe anterior fixation, but 22846 is selected for four to seven vertebral segments rather than two or three.
- 22847Spinal fixation
- 22847 describes anterior fixation spanning eight or more vertebral segments; 22845 is limited to two or three.
- 22842Spinal fixation
- 22842 describes posterior segmental fixation. Choose based on the documented approach and construct, not simply because the same fusion was performed.
- 22853Interbody device
- 22853 describes an interbody biomechanical device placed in a disc space; 22845 describes anterior spinal fixation across vertebral segments.
22845 billing questions
How is 22845 distinguished from 22846?
22845 is for anterior fixation spanning two or three vertebral segments. 22846 applies when the anterior fixation spans four to seven segments.
Can 22845 be billed by itself?
No. It is an add-on code and must be reported with an eligible primary procedure; Medicare payment is handled within that procedure’s global period.
What documentation supports the segment count?
The operative report should describe the anterior fixation device and identify the vertebral segments it spans. Count the instrumented segments rather than assuming the count from the number of treated disc spaces.
Is an interbody cage reported with 22845?
The codes describe different work: 22845 represents anterior fixation, while 22853 describes placement of an interbody biomechanical device. They may be reported for distinct work in the same fusion operation when documented.
Does 22845 describe the fusion itself?
No. It describes supplemental anterior stabilization. Report the applicable primary fusion or other procedure separately.
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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