No office rate
22840 is for initial placement of posterior nonsegmental fixation. Use 22849 when a previously placed device is reinserted.
On this page
CMS RVU26D · Effective 2026-10-01
22849 Spinal fixation Medicare reimbursement rates in Rhode Island
Reports reinsertion of a previously placed spinal fixation device during spine surgery, rather than initial placement of a new fixation construct. Compare 22849 office and facility rates across CMS payment localities in Rhode Island.
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 22849 in Rhode Island?
Rhode Island has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1231.34
1 of 1 localities have a supported rate.
Payment area: Rhode Island
One mapped payment locality.
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 instrumentation
About 22849: Spinal fixation device reinsertion
Reports reinsertion of a previously placed spinal fixation device during spine surgery, rather than initial placement of a new fixation construct.
A spine surgeon reports this service when a previously placed fixation device is reinserted as part of an operation, such as a revision procedure in which the existing device is removed and then returned to the spine. The operative report should identify the prior fixation and describe the steps supporting reinsertion; simply placing a new construct is not this service. These procedures are generally performed in a hospital or ambulatory surgical setting.
Choose this code for reinsertion, not by counting vertebral segments or selecting the code for initial placement. Document the device and the reason it was reinserted, along with any related fusion or instrumentation work. Medicare 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 others at 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
CMS billing rules for 22849
- 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 RVU18.69 · 51%
- Practice expense (office) RVU12.26 · 33%
- Malpractice RVU5.78 · 16%
4.7K
Medicare services in 2024 · #1907 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.
22849 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
22842 covers initial posterior segmental fixation across 3 to 6 vertebral segments. It is not selected for reinsertion based on segment count.
No office rate
22850 reports removal of posterior nonsegmental instrumentation. It describes removal, whereas 22849 describes reinsertion of a previously placed fixation device.
No office rate
22852 reports removal of posterior segmental instrumentation. Use 22849 for the distinct service of reinserting a previously placed device.
Compare 22849 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.
1 of 1 payment localities
Rhode Island →
Office / nonfacility
Unavailable
Facility
$1231.34
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 22849 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
2,121
- Code
- 22849
- Physician work
- 18.69
- Practice expense
- 12.26
- Malpractice
- 5.78
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 18.69 | × 1.019 | 19.0451 |
| Practice expense | 12.26 | × 1.033 | 12.6646 |
| Malpractice | 5.78 | × 0.892 | 5.1558 |
| Total RVUs | 36.8655 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1231.34
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 18.69 | 1.019 |
| Practice expense | 12.26 | 1.033 |
| Malpractice | 5.78 | 0.892 |
(18.69 × 1.019 + 12.26 × 1.033 + 5.78 × 0.892) × $33.4009 = $1231.34
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
22849 billing questions
How is reinsertion different from initial spinal fixation placement?
Use 22849 when a previously placed fixation device is reinserted. Initial placement of a new construct is reported with the applicable insertion code, selected for the approach and construct.
What operative documentation supports 22849?
Identify the previously placed device and describe its removal and reinsertion during the operation. The record should make clear that the service was reinsertion rather than placement of a new construct.
Can removal of the existing device be reported separately?
The operative report should distinguish any removal work from reinsertion. Do not assume a separate removal code is supported solely because the device was handled during the reinsertion procedure.
Does modifier 50 apply when fixation is reinserted on both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code; do not use modifier 50.
What Medicare 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?
Assistant-at-surgery payment may be available. Co-surgeon payment requires supporting documentation; team surgery is not permitted.
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.
2,11822846,,Insert spine fixation device,A,,12.09,4.06,NA,4.06,,4.01,20.16,20.16,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11922847,,Insert spine fixation device,A,,13.44,4.28,NA,4.28,,2.86,20.58,20.58,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12022848,,Insert pelv fixation device,A,,5.84,1.93,NA,1.93,,1.74,9.51,9.51,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12122849,,Reinsert spinal fixation,A,,18.69,12.26,NA,12.26,,5.78,36.73,36.73,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12222850,,Remove spine fixation device,A,,9.57,8.88,NA,8.88,,3.01,21.46,21.46,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12322852,,Remove spine fixation device,A,,9.14,8.73,NA,8.73,,2.85,20.72,20.72,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,12422853,,Insj biomechanical device,A,,4.14,1.38,NA,1.38,,1.33,6.85,6.85,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537