Fusion · Spine

Add-on code for each additional interspace treated via anterior interbody arthrodesis, including minimal discectomy to prepare the disc space, beyond the first interspace reported with the primary code.

Verified May 8, 2026 · 7 sources ↓

Medicare: $287.58
Total RVUs: 8.61
Global, days
Region: Spine

Drawn from CMSSrsHealthcareinspiredllcAAOS

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 7 cited references ↓

Operative note must identify each interspace treated by level (e.g., L4-5, L5-S1) and confirm the anterior or anterolateral approach was used at each level.
Distinguish minimal discectomy for interspace preparation from decompressive discectomy — the operative note must make clear the disc removal served fusion prep, not neural decompression.
If modifier 62 is used, each co-surgeon must submit a separate operative report documenting their distinct intraoperative contribution at every level billed.
Number of interspaces treated must be explicitly stated; a generic reference to 'multi-level fusion' is insufficient to support multiple units of 22585.
Primary anterior interbody arthrodesis code (22548–22558) must appear on the same claim; 22585 cannot be billed as a standalone code.
Diagnosis codes must support each level fused — document segmental instability, degenerative disc disease, or other indication per level in the H&P and imaging reports.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 22585 is an add-on code billed once per additional interspace when an anterior interbody arthrodesis extends beyond the single interspace covered by the primary code (22548–22558). It includes the minimal discectomy required to prepare the interspace for fusion — not decompressive discectomy, which is a separate clinical service. Because it is an add-on code, it carries a ZZZ global period and attaches to the global period of the primary procedure.

The primary codes it pairs with are the anterior interbody arthrodesis family: 22548 (occiput–C2), 22551 (cervical), 22552 (additional cervical, itself an add-on), 22554 (cervicothoracic), 22556 (thoracic), and 22558 (lumbar). For lumbar single-interspace anterior fusion, 22558 is the base; 22585 is reported for each additional lumbar interspace beyond that first one. The code is used by orthopedic surgeons, neurosurgeons, and general surgeons performing anterior spinal approaches across all spinal regions.

Modifier 51 exemption applies — do not append modifier 51 to 22585. When two surgeons work as co-primary surgeons throughout the entire anterior interbody procedure, modifier 62 may be appended to both the primary code and to 22585, provided both surgeons continue their co-primary role at each additional level. Note: CMS removed 22585 from the cervical fusion billing and coding article (A59674) effective August 2024; confirm MAC-specific coverage policies before billing in that context.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.38
Practice expense RVU	1.62
Malpractice RVU	1.61
Total RVU	8.61
Medicare national rate	$287.58
Global period	days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$287.58

Common denial reasons

The recurring reasons claims for CPT 22585 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Billed without a valid primary anterior interbody arthrodesis code on the same claim — 22585 is an add-on code and cannot stand alone.
Modifier 51 appended in error; add-on codes are modifier 51 exempt and some payer systems auto-deny when 51 is attached to 22585.
Units of 22585 exceed the number of additional interspaces documented in the operative report.
Decompressive discectomy at the same level coded separately (e.g., 63030) — CMS NCCI edits restrict bundling of decompression codes with arthrodesis codes at the same level; inadequate documentation distinguishing the two services triggers bundling denials.
Modifier 62 appended when only one surgeon performed the additional level work, or when co-surgeon documentation is absent or asymmetric.
MAC-specific LCD non-coverage: following CMS removal of 22585 from the cervical fusion billing article (A59674) in August 2024, some MACs deny 22585 in certain cervical fusion contexts without additional supporting documentation.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01How many times can I bill 22585 on a single claim?

Once per additional interspace beyond the first. If you perform a 3-level anterior lumbar fusion at L3-4, L4-5, and L5-S1, bill 22558 for the first level and 22585 twice for the remaining two. Each unit must correspond to a documented interspace in the operative report.

02Does 22585 need modifier 51?

No. It is an add-on code and is exempt from modifier 51. Appending modifier 51 to 22585 is an error that can trigger a denial from payers whose systems flag that combination.

03Can modifier 62 be used with 22585?

Yes, when two surgeons act as co-primary surgeons for the entire anterior interbody procedure — including the additional levels. Both surgeons must document their distinct contributions at every level and each submits modifier 62 on both the primary code and 22585.

04What is the primary code that must accompany 22585?

One of the anterior interbody arthrodesis codes: 22548, 22551, 22552, 22554, 22556, or 22558, depending on the spinal region and approach. The specific pairing depends on the region — 22558 for lumbar, 22554 for cervicothoracic, etc. 22585 cannot be billed without a valid primary from this family on the same claim.

05Can I separately bill a decompressive discectomy at the same level as 22585?

The minimal discectomy bundled into 22585 is for interspace preparation only — not decompression. If you perform additional decompression beyond what is needed to prepare the disc space, CPT guidelines allow separate reporting, but CMS NCCI edits have restricted this for certain code pairs since 2015. For Medicare, do not assume separate decompression codes (e.g., 63030, 63047) at the same level are payable alongside 22585 without confirming current NCCI edit status and modifier bypass eligibility.

06What changed with CMS's cervical fusion billing article and 22585?

CMS removed 22585 (and 22614) from the cervical fusion billing and coding article A59674 effective August 11, 2024. Verify with your MAC whether this affects coverage for 22585 in cervical contexts before billing, as local coverage determinations vary.

07What ICD-10 diagnoses support 22585?

The diagnosis must support arthrodesis at each level billed — commonly degenerative disc disease (M51.x6, M51.x7), spondylolisthesis (M43.1x), segmental instability, or post-laminectomy syndrome. Each additional level needs a supported indication; a single diagnosis code covering one level does not automatically justify multiple units of 22585.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the surgical approach (anterior vs. anterolateral), the exact spinal levels fused, and explicitly notes whether disc removal at each level was performed to prepare the interspace for fusion rather than for neural decompression. It also flags co-surgeon participation per level to support modifier 62 decisions. This prevents the most common 22585 denials: missing primary code linkage, unit count mismatches against the operative note, and bundling challenges when decompression language bleeds into the fusion description.

See how Mira captures CPT 22585 documentation