Posterior interbody arthrodesis of a single lumbar interspace, including laminectomy and/or discectomy performed to prepare the interspace for fusion rather than for decompression.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,510.72
- Total RVUs
- 45.23
- 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 5 cited references ↓
- Specify the exact interspace fused (e.g., L4-L5) — not just 'lumbar level'
- Document that laminectomy/discectomy was performed to prepare the interbody space, not as a standalone decompression
- Identify the surgical approach by name (e.g., PLIF, TLIF posterior approach) and confirm it is a posterior interbody technique
- Record bone graft type and source (autograft, allograft, synthetic) and interbody device used, if any
- State the indication: diagnosis supporting fusion (e.g., spondylolisthesis, degenerative disc disease with instability, prior failed decompression)
- If modifier 22 is appended, the operative note must quantify the added work — prior surgery scarring, anatomy distortion, or excessive bleeding — not just state it
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 5 cited references ↓
22630 covers a lumbar posterior interbody fusion (PLIF) at one interspace. The surgeon accesses the disc space from a posterior approach, removes the lamina and disc material as needed to prepare the interbody space, then places bone graft or an interbody device to achieve fusion. The laminectomy and discectomy are incidental to the fusion prep — if the primary intent is decompression alone, this code does not apply. 22630 is reported per interspace; use add-on code 22632 for each additional interspace at the same operative session.
Not to be confused with 22633, which covers the combined posterior/posterolateral technique performed alongside posterior interbody fusion at the same interspace. The NCCI PTP edit between 22630 and 22633 is non-bypassable at the same interspace — if you're doing both at the same level, 22633 is the correct single code. If performed at different interspaces, modifier 59 or XS separates them. CMS deleted the PTP edits between 22630 (and related fusion codes) and add-on codes 63052/63053 effective October 1, 2023, so those combinations no longer require a modifier.
The 90-day global covers all routine post-op care. Return to the OR for a related complication bills with modifier 78; an unrelated procedure during the global period uses modifier 79. A staged secondary fusion level planned from the outset uses modifier 58 and resets the global clock.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 21.54 |
| Practice expense RVU | 15.81 |
| Malpractice RVU | 7.88 |
| Total RVU | 45.23 |
| Medicare national rate | $1,510.72 |
| 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 | $1,510.72 |
HOPD (APC 5117) Hospital outpatient department | $27,721.73 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $20,858.55 |
Common denial reasons
The recurring reasons claims for CPT 22630 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billing 22630 and 22633 at the same interspace triggers a non-bypassable NCCI PTP edit — use 22633 alone when both techniques are performed at one level
- Lack of medical necessity documentation: payers require evidence of conservative treatment failure before authorizing lumbar fusion
- Reporting 22630 alongside a standalone decompression code (e.g., 63056) at the same spinal level without a modifier — NCCI bundles these at the same anatomic site
- Missing or mismatched diagnosis codes: ICD-10 must support instability or fusion indication, not just disc herniation or radiculopathy alone
- Failure to obtain prior authorization — most commercial payers and Medicare Advantage plans require pre-auth for lumbar fusion procedures
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01What is the difference between 22630 and 22633?
02When do I add 22632 to a claim with 22630?
03Can 22630 and 63056 be billed together?
04Does modifier 62 apply to 22630?
05What global period applies, and what does that mean for post-op billing?
06Is prior authorization required for 22630?
07When is modifier 22 appropriate on 22630?
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/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
- 03cms.govhttps://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
- 04cms.govhttps://www.cms.gov/files/document/2025nccimedicarepolicymanualcompletepdf.pdf
- 05aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
Mira AI Scribe
Mira's AI scribe captures the interspace level, surgical approach name, purpose of the laminectomy/discectomy (fusion prep vs. decompression), graft type, and any interbody device from dictation. This prevents the most common audit flag on 22630 notes: operative reports that don't distinguish fusion-prep discectomy from standalone decompression, which triggers downcoding or bundling into a decompression-only code.
See how Mira captures CPT 22630 documentation