Fusion · Spine

Single-level lumbar arthrodesis combining posterior or posterolateral technique with posterior interbody technique, including laminectomy and/or discectomy sufficient to prepare the interspace — performed as one surgical session at one lumbar interspace.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,700.11
Total RVUs: 50.9
Global, days: 90
Region: Spine

Drawn from CMSMedicaidAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must explicitly state that both posterolateral AND posterior interbody techniques were performed at the same interspace — not just one or the other.
Identify the specific lumbar level fused (e.g., L4–L5) and confirm single interspace; multilevel work requires add-on codes.
Document that disc space preparation via laminectomy and/or discectomy was performed for fusion purposes, not solely for neural decompression.
If instrumentation codes are billed, document hardware type, placement, and that it was placed through a single skin incision.
Record bone graft type and source (autograft, allograft, bone marrow aspirate); bone marrow harvesting for transplantation (38230/38232) cannot be reported for aspirate procurement here.
If modifier 22 is appended, the operative note must quantify the substantially increased work and the clinical reason for it — a general statement of difficulty is insufficient.

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22633 covers a combined lumbar fusion at a single interspace where the surgeon performs both a posterolateral arthrodesis and a posterior interbody arthrodesis (PLIF or TLIF approach) through the same operative session. The interbody component requires laminectomy and/or discectomy adequate to access and prepare the disc space — not merely for decompression. This distinguishes 22633 from 22630 (posterior interbody only) and 22612 (posterior/posterolateral only): 22633 is the correct primary code when both techniques are executed at the same level.

For additional lumbar interspaces using the same combined technique, report add-on code 22634 — not a second unit of 22633. If an additional level uses only the posterior interbody technique, 22632 is the appropriate add-on. If only posterolateral technique is added, use 22614. CMS NCCI policy prohibits separate billing of 63042 (laminotomy, lumbar) or 63047 (laminectomy, lumbar) at the same interspace as 22633 — the decompression work is integral. If those procedures occur at a different interspace, append modifier 59 or XS to unbundle.

Instrumentation codes (22840–22847) are commonly reported alongside 22633 but only one instrumentation code per skin incision is allowed. Interbody device insertion (22853, 22854) is separately reportable; however, any integral anterior fixation anchoring that device is not. The 90-day global period applies — all routine postoperative care through day 90 is bundled.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	26.13
Practice expense RVU	16.31
Malpractice RVU	8.46
Total RVU	50.9
Medicare national rate	$1,700.11
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	$1,700.11
HOPD (APC 5117) Hospital outpatient department	$27,721.73
ASC (PI J8) Ambulatory surgical center (freestanding)	$20,841.42

Common denial reasons

The recurring reasons claims for CPT 22633 get rejected.

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

Billing 22633 and 22630 or 22612 at the same interspace — NCCI bundles these; only 22633 is payable when both techniques are combined at one level.
Reporting 63042 or 63047 at the same interspace as 22633 without a modifier — CMS does not allow separate payment for that decompression when it's integral to the fusion approach.
Reporting a second unit of 22633 for an additional level instead of using add-on code 22634 — 22633 has an MUE of 1 as a primary code.
Missing or vague operative documentation that doesn't confirm both the posterolateral and interbody components were performed, causing payers to downcode to 22630 or 22612.
Appending modifier 50 (bilateral) to 22633 — lumbar interbody fusion at a single interspace is a unilateral procedure by definition and bilateral billing is not clinically supported here.

Frequently asked questions

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

01What is the difference between 22633 and 22630?

22630 covers posterior interbody arthrodesis only. 22633 is used when the surgeon also performs a posterolateral arthrodesis at the same interspace in the same session — the combined technique. If your operative note documents both components, 22633 is the correct primary code.

02How do I code a second lumbar level when 22633 is the primary?

Use add-on code 22634 for each additional level treated with the same combined technique. If the additional level uses only posterior interbody technique, use 22632. If only posterolateral, use 22614. Never report a second unit of 22633.

03Can I separately bill a laminectomy (63047) at the same interspace as 22633?

No. CMS NCCI policy bundles 63042 and 63047 into 22633 at the same interspace. If decompression was performed at a different level, report 63042 or 63047 with modifier 59 or XS to support separate payment.

04Is modifier 62 (co-surgery) applicable to 22633?

Yes, when two surgeons of different specialties each perform a distinct portion of the combined procedure — for example, one surgeon handles the interbody component and the other the posterolateral component. Both surgeons append modifier 62, and each bills 22633. Documentation must support each surgeon's distinct role.

05Can I report interbody device insertion (22853) with 22633?

Yes, 22853 is separately reportable with 22633 for insertion of an interbody biomechanical device. However, any instrumentation integral to anchoring that device (anterior fixation) is not separately billable. Additional plate or rod fixation unrelated to device anchoring may be reported with modifier 59 or XU.

06Does the 90-day global period affect post-op billing after a 22633 case?

Yes. The 90-day global bundles all routine post-op visits, wound checks, and stitch removals through day 90. Bill unrelated E/M services with modifier 24 and related staged or unplanned returns to the OR with modifier 78 (related) or 79 (unrelated).

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 lumbar interspace fused, the explicit use of both posterolateral and posterior interbody techniques in the same session, the laminectomy and/or discectomy performed for interspace preparation (distinct from decompression), graft type, and instrumentation details. This documentation prevents downcoding to 22630 or 22612 and blocks NCCI bundling challenges when decompression codes are billed at separate levels.

See how Mira captures CPT 22633 documentation