No office rate
Both describe lumbar interbody fusion, but 22586 is specific to the presacral approach at L5-S1; 22558 is used for an anterior approach.
On this page
CMS RVU26D · Effective 2026-10-01
22586 Spinal fusion Medicare reimbursement rates in Virginia
Reports single-level L5-S1 interbody fusion performed through a presacral approach, with preparation of the disc space for arthrodesis. Compare 22586 office and facility rates across CMS payment localities in Virginia.
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 22586 in Virginia?
Virginia 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
$1882.26–$2226.77
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 22586: Presacral L5-S1 interbody fusion
Reports single-level L5-S1 interbody fusion performed through a presacral approach, with preparation of the disc space for arthrodesis.
This code describes fusion of the L5-S1 disc space reached through a presacral corridor, rather than through a conventional anterior abdominal exposure. The surgeon prepares the disc space and places graft or an interbody construct to promote fusion. It is generally performed by a spine surgeon in a hospital operating room for selected patients needing lower-lumbar fusion; the operative report should establish the presacral route and the L5-S1 level.
Report it for the single L5-S1 interspace, not by the number of implants or graft materials. Documentation should identify the approach, level, fusion work, and any separately performed procedures. CMS assigns a 90-day global period, including the day-before preoperative visit and related postoperative care during that period. When multiple procedures are performed in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Modifier 50 is inappropriate for this single midline interspace. Assistant-at-surgery payment and co-surgeon billing are permitted; team surgery is not.
CMS billing rules for 22586
- 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 permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU27.42 · 46%
- Practice expense (office) RVU21.11 · 35%
- Malpractice RVU11.59 · 19%
87
Medicare services in 2024 · #4980 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.
22586 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
22533 describes lumbar arthrodesis through a lateral extracavitary approach. Use 22586 for the presacral route to the L5-S1 disc space.
No office rate
22585 is an additional-interspace code associated with specified anterior interbody arthrodesis codes. It does not describe the single presacral L5-S1 fusion reported with 22586.
Compare 22586 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
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$2226.77
Virginia →
Office / nonfacility
Unavailable
Facility
$1882.26
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22586 billing questions
How is this different from 22558?
22586 is for a presacral route to the L5-S1 interspace. 22558 describes lumbar anterior interbody fusion through an anterior approach.
Can modifier 50 be used for this fusion?
No. The code is specific to the single midline L5-S1 interspace, so a bilateral adjustment is inappropriate.
What does the 90-day global period include?
It includes the day-before preoperative visit and related postoperative care for 90 days after surgery.
How does CMS pay when other procedures are performed in the same session?
The highest-valued procedure is paid in full, and the other procedures are subject to the standard 50% multiple-procedure reduction.
May an assistant or another surgeon be reported?
CMS permits assistant-at-surgery payment and co-surgeon billing for this code. Team-surgery payment is not permitted.
What should the operative report establish?
Document the presacral approach, the L5-S1 level, and the disc-space preparation and fusion performed. The code represents one interspace.
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.
2,08622556,,Arthrd ant ntrbd min dsc thc,A,,24.08,16.08,NA,16.08,,7.71,47.87,47.87,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08722558,,Arthrd ant ntrbd min dsc lum,A,,22.94,13.20,NA,13.20,,6.49,42.63,42.63,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08822585,,Arthrd ant ntrbd min dsc ea,A,,5.38,1.62,NA,1.62,,1.61,8.61,8.61,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,08922586,,Arthrd pre-sac ntrbdy l5-s1,A,,27.42,21.11,NA,21.11,,11.59,60.12,60.12,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,09022590,,Arthrd pst tq craniocervical,A,,21.22,17.41,NA,17.41,,8.05,46.68,46.68,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,09122595,,Arthrd pst tq atlas-axis,A,,20.12,17.09,NA,17.09,,7.67,44.88,44.88,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,09222600,,Arthrd pst tq 1ntrspc crv,A,,16.97,15.37,NA,15.37,,6.07,38.41,38.41,0,090,0.10,0.69,0.21,2,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00