Fusion · Spine

Posterior or posterolateral lumbar arthrodesis of a single interspace, performed via a posterior approach with bone graft and typically pedicle screw fixation to achieve vertebral segment fusion.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,467.64
Total RVUs: 43.94
Global, days: 90
Region: Spine

Drawn from CMSKzanowHealthcareinspiredllc

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact interspace(s) fused by level name (e.g., L4–L5), not just 'lumbar spine'
Document the surgical approach explicitly — posterior, posterolateral, or lateral transverse process technique
Identify graft type and source: autograft (harvest site noted), allograft, or synthetic bone substitute
Note whether instrumentation (pedicle screws, rods) was placed and at which levels — required for separate instrumentation code support
Record the indication for fusion with supporting imaging findings and conservative treatment failure history to satisfy LCD L37848 requirements
State the number of interspaces treated in the operative note to support primary vs. add-on code selection

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 50 Bilateral procedure 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 6 cited references ↓

CPT 22612 covers a single-level lumbar spinal fusion performed through a posterior or posterolateral approach. The surgeon accesses the vertebral segment from the back, prepares the transverse processes or posterior elements, and places bone graft — autograft, allograft, or a combination — to achieve bony union across the interspace. Pedicle screw instrumentation is routinely placed at the same session but reported separately under the appropriate instrumentation codes.

This is a primary code, reported once per operative session for the first lumbar interspace. For each additional lumbar interspace fused using the same technique, add-on code 22614 is required. If the procedure also includes a posterior interbody component (e.g., TLIF or PLIF), report 22630 or 22633 instead — not 22612 plus an interbody code. When fusion crosses a thoracic-lumbar junction (e.g., T11–L3), select one primary code where the majority of work occurs, then use 22614 for each remaining interspace. Do not stack 22610 and 22612 as co-primary codes.

The 90-day global period covers the day-before visit, the surgery, and all routine post-op care through day 90. Services unrelated to the fusion in that window require modifier 24 (E/M) or 79 (procedure). Arthrodesis combined with a separate definitive procedure such as laminectomy or decompression takes modifier 51 on the secondary code. Co-surgeon arrangements under modifier 62 are permitted; team surgery (modifier 66) is not.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	22.94
Practice expense RVU	14.38
Malpractice RVU	6.62
Total RVU	43.94
Medicare national rate	$1,467.64
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	$1,467.64
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,491.52

Common denial reasons

The recurring reasons claims for CPT 22612 get rejected.

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

Missing documentation of failed conservative treatment, which Medicare LCD L37848 requires before approving lumbar fusion
22610 and 22612 billed as co-primary codes in the same session — only one primary arthrodesis code is allowed per session regardless of junction crossings
Add-on code 22614 billed without a valid primary code (22612, 22600, 22610, 22630, or 22633) on the same claim
Instrumentation codes denied when the operative note doesn't specify instrumented levels or implant type
Global period violations — E/M or procedure codes billed within 90 days post-op without modifier 24 or 79
Modifier 51 applied to add-on codes 22614 or 22632, which are exempt from multiple-procedure reduction

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 22612 and 22610 together when fusion crosses the thoracolumbar junction?

No. Pick one primary code — whichever level represents the majority of the work, typically lumbar so 22612 — and use add-on code 22614 for every additional interspace. Billing 22610 and 22612 as co-primary codes in the same session is incorrect and will be denied.

02Which add-on codes can I pair with 22612?

22614 (additional interspace, same technique) and 22632 (additional interspace, posterior interbody technique) are both valid add-ons with 22612 as the primary per NCCI policy. Do not apply modifier 51 to either add-on — they are exempt from multiple-procedure reduction.

03Does 22612 include the bone graft harvest?

No. If autograft is harvested through a separate incision, that work may be separately reportable. Graft harvested through the same incision is generally considered part of the fusion and not separately billable. Confirm with the NCCI PTP edits and your payer contract.

04Can two surgeons each bill 22612 with modifier 62 for a posterior lumbar fusion?

Yes. Modifier 62 is allowed for 22612 when two surgeons perform distinct portions of the procedure as co-primary surgeons. Each surgeon appends modifier 62 to 22612, and modifier 62 may also be applied to add-on code 22614 if both surgeons function as co-primaries for the entire procedure.

05What is the global period for 22612 and what does it cover?

22612 carries a 90-day global period. That covers the day-before pre-op visit, the procedure itself, and all routine follow-up through day 90 — including wound checks, dressing changes, and suture removal. Any E/M visit unrelated to the fusion needs modifier 24; an unrelated procedure in that window needs modifier 79.

06Should I use 22612 or 22633 when a TLIF is performed at the same level?

Use 22633, not a combination of 22612 and a separate interbody code. CPT 22633 describes combined posterior or posterolateral arthrodesis with posterior interbody technique at the same level — that's the single code that captures a TLIF or PLIF plus posterior fusion at one interspace.

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 approach (posterior vs. posterolateral), the exact interspace by level name, graft source and type, instrumentation levels, and the number of interspaces treated — all from dictation. That specificity prevents the two most common audit flags: vague approach documentation and level-count mismatches between the operative note and the claim that trigger 22614 add-on denials.

See how Mira captures CPT 22612 documentation