Arthrodesis at the lumbosacral junction (L5-S1) performed via a presacral, retroperitoneal interbody approach with implant placement.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $2,008.06
- Total RVUs
- 60.12
- Global, days
- 90
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Specify the approach by name: presacral, retroperitoneal interbody — not just 'minimally invasive' or 'posterior'
- Confirm the operative level is L5-S1; this code is level-specific and not applicable to other lumbar segments
- Document the implant type and size placed into the disc space
- Record duration and nature of conservative treatment failure prior to surgical decision
- Include pre-op imaging (MRI or CT) correlating pathology to the operative level
- Document intraoperative fluoroscopy or navigation use separately if performed, as it may be separately billable
- Operative note must name the specific surgical approach — audit teams flag notes that say 'standard minimally invasive approach' without further detail
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 22586 describes a presacral interbody fusion at L5-S1 — a minimally invasive approach that accesses the disc space through a small incision near the coccyx, anterior to the sacrum, without requiring a formal anterior or posterior open exposure. An implant is placed into the L5-S1 disc space to achieve interbody fusion. The 90-day global period covers all routine postoperative management through day 90. Any unrelated procedure performed during the global window requires modifier 79; a staged or related procedure requires modifier 78.
This code is specific to the L5-S1 level and the presacral route. Do not report it for standard anterior lumbar interbody fusion (ALIF) at L5-S1 — that is 22558. If instrumentation (pedicle screws, rods) is added, report the appropriate spinal instrumentation add-on codes separately. Intraoperative imaging used for navigation or localization is separately reportable when performed. The approach itself is not separately billable.
Site of service matters significantly here. ASC payment rates differ from HOPD rates — see the Site of Service comparison on this page. Many payers require prior authorization for spinal fusion procedures; confirm requirements before scheduling. Document the specific indication (spondylolisthesis grade, disc pathology, failed conservative care duration) to support medical necessity, as fusion at a single level with a novel access route draws scrutiny from both Medicare contractors and commercial payers.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 27.42 |
| Practice expense RVU | 21.11 |
| Malpractice RVU | 11.59 |
| Total RVU | 60.12 |
| Medicare national rate | $2,008.06 |
| Global period | 90 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 | $2,008.06 |
HOPD (APC 5116) Hospital outpatient department | $17,913.59 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $13,933.19 |
Common denial reasons
The recurring reasons claims for CPT 22586 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity not established: insufficient documentation of failed conservative care (typically 6 weeks to 3 months minimum for most payers)
- Wrong code for approach: 22586 billed when operative note describes an anterior or posterior open approach, which maps to different CPT codes
- Missing prior authorization: many payers require pre-certification for any spinal fusion; claim denied on submission without auth
- Global period violation: postoperative E&M visits billed without modifier 24 during the 90-day global window
- Unbundling error: approach reported separately in addition to 22586, which is a column-two NCCI edit target
- Diagnosis mismatch: ICD-10 code does not support single-level L5-S1 fusion (e.g., degenerative disc disease coded at wrong level or without specificity)
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01What is the difference between CPT 22586 and CPT 22558?
02Can I bill instrumentation add-on codes with 22586?
03Is modifier 62 ever appropriate with 22586?
04What ICD-10 codes typically support medical necessity for 22586?
05Does the 90-day global period affect how I bill post-op physical therapy orders or pain management referrals?
06Is 22586 performed in an ASC or hospital outpatient department?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 03cms.govhttps://www.cms.gov/files/document/medicaid-ncci-policy-manual-2024-chapter-1.pdf
- 04uhcprovider.comhttps://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-reimbursement/MEDADV-Rebundling-and-NCCI-Edits-Policy.pdf
Mira AI Scribe
Mira's AI scribe captures the approach name (presacral retroperitoneal), operative level (L5-S1), implant description, intraoperative imaging details, and the clinical rationale linking pre-op imaging findings to the surgical indication. This prevents the most common audit flag for 22586 — an operative note that confirms the incision site but fails to document the presacral corridor and implant placement in sufficient detail to distinguish this approach from a standard ALIF.
See how Mira captures CPT 22586 documentation