Fusion · Spine

Add-on code for each additional interspace treated by posterior or posterolateral arthrodesis beyond the first level billed with a primary fusion code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $349.37
Total RVUs: 10.46
Global, days
Region: Spine

Drawn from CMSHealthcareinspiredllcNervesAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify each interspace treated by level designation (e.g., L4-L5, L5-S1) in the operative note
Name the surgical technique at each level (posterior, posterolateral, or lateral transverse process)
Document all bone grafts used — type (autograft, allograft), harvest site, and add-on graft codes billed
Record trade names of all instrumentation and implants placed to support separately billed hardware codes
Identify the primary arthrodesis code (22600, 22610, 22612, 22630, or 22633) that 22614 accompanies
Document medical necessity for each additional level fused, including imaging findings and clinical rationale

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

22614 is an add-on code (AOC) billed once per additional interspace when a posterior, posterolateral, or lateral transverse process arthrodesis extends beyond the single level captured by the primary procedure. It carries a ZZZ global period, meaning it inherits the global period of the primary code it accompanies — never reported alone. Per the CMS NCCI Policy Manual 2026, 22614 may only be reported alongside primary codes 22600, 22610, 22612, 22630, or 22633. Do not append modifier 51 to this add-on code.

For multilevel constructs within the same spinal region through the same incision, report the primary code for the first interspace and 22614 for each additional interspace. If the construct spans two spinal regions through the same incision, the same rule applies — one primary, 22614 for each additional level. When two separate skin incisions are used across different spinal regions, the second region may carry its own primary code. Bone graft and instrumentation codes are separately reportable and must be documented to support medical necessity.

Two-surgeon (modifier 62) reporting is applicable when both surgeons act as co-primary surgeons for the entire construct. If a PA, NP, or CNS assists, append modifier AS to the assistant's claim. Document implant trade names, graft source, and the specific technique at each interspace — audit reviewers target multilevel fusion claims for level-count mismatches between the operative note and the claim.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	6.27
Practice expense RVU	2.11
Malpractice RVU	2.08
Total RVU	10.46
Medicare national rate	$349.37
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	$349.37

Common denial reasons

The recurring reasons claims for CPT 22614 get rejected.

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

Reported without a valid primary code — 22614 cannot stand alone and has no recognized primary pairing outside 22600, 22610, 22612, 22630, or 22633
Level count on the claim exceeds the number of interspaces documented in the operative report
Modifier 51 appended in error — add-on codes are exempt from multiple-procedure reduction and modifier 51 triggers incorrect payment logic
Primary code billed is not an approved pairing per NCCI (e.g., appended to 22633 when 22634 is the correct additional-level AOC for combined posterior-interbody)
Missing bone graft documentation — payers may deny the fusion construct entirely if graft codes lack supporting operative detail

Frequently asked questions

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

01Which primary codes can be billed with 22614?

Per the CMS NCCI Policy Manual 2026, 22614 pairs only with 22600, 22610, 22612, 22630, or 22633. Pairing it with any other primary code will trigger an NCCI edit.

02Should modifier 51 be appended to 22614?

No. 22614 is an add-on code and is exempt from modifier 51. Appending it incorrectly can cause payment errors or claim rejection.

03How many times can 22614 be reported on a single claim?

Once per additional interspace beyond the first level. A three-level posterior fusion billed as 22612 + 22614 x2 is correct; confirm each level is individually documented in the op note.

04Can 22614 be used when the fusion spans two different spinal regions?

If the same skin incision is used across two regions (e.g., thoracic and lumbar), report one primary code for the first interspace and 22614 for each additional interspace across both regions. Separate incisions through different regions may allow a second primary code — document the incision approach explicitly.

05Is modifier 62 allowed on 22614?

Yes, when two surgeons serve as co-primary surgeons for the full multilevel construct, modifier 62 may be appended to both the primary code and 22614 on each surgeon's claim.

06Does 22614 require a separate bone graft code?

Bone graft codes (e.g., 20930, 20931, 20936–20938) are separately reportable for each level fused and must be supported by documentation identifying graft type, source, and use at each interspace. Absence of graft documentation is a common reason payers deny multilevel fusion claims in their entirety.

07What global period applies to 22614?

ZZZ — add-on codes have no independent global period and inherit the global period of the primary procedure code they accompany.

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 specific interspace label (e.g., L4-L5, L5-S1), the technique name, graft type and harvest site, implant trade names, and the primary procedure code for each operative dictation involving multilevel posterior arthrodesis. That level-by-level capture prevents the most common audit flag on 22614 claims: a mismatch between the number of add-on units billed and the number of additional interspaces documented in the operative note.

See how Mira captures CPT 22614 documentation