Fusion · Spine

Add-on code for each additional interspace and segment of combined posterior/posterolateral and posterior interbody lumbar arthrodesis, including laminectomy and/or discectomy sufficient to prepare the disc space.

Verified May 8, 2026 · 6 sources ↓

Medicare: $432.54
Total RVUs: 12.95
Global, days
Region: Spine

Drawn from CMSMedtronicSrsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify each interspace and segment treated by level (e.g., L4-5, L5-S1) so the number of add-on units billed is auditable.
Operative note must distinguish the combined technique (posterior/posterolateral plus posterior interbody) from a single-approach fusion to justify 22633 as the primary and 22634 as the add-on.
Document that laminectomy and/or discectomy was performed to prepare the disc space, not solely for neural decompression, to avoid unbundling disputes.
Specify bone graft type and source (autograft, allograft, BMP) with separate coding support for 20930, 20936, or equivalent if reported.
If 63052 or 63053 is billed at the same level, document the additional decompressive work beyond what was required for disc space preparation to substantiate separate payment.
Co-surgeon or assistant-at-surgery arrangements must be reflected in the operative note and supported with modifier 62 or AS on the claim.

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 76 Repeat, same physician 77 Repeat, another physician 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

22634 is a ZZZ add-on code billed alongside primary code 22633 for every additional interspace and segment treated using the combined posterior or posterolateral technique with posterior interbody technique. It covers the laminectomy and/or discectomy work necessary to access and prepare the disc space — not decompression performed for its own clinical purpose. You cannot bill 22634 without a primary 22633 on the same claim.

The NCCI Policy Manual explicitly restricts 22634's use as an add-on to primary code 22633 only. If the surgeon uses different primary codes for other levels or regions, the add-on structure doesn't transfer — report a new primary code for that region's first interspace. When the procedure spans two spinal regions through the same incision, CMS requires a primary code for the first interspace in each region with the appropriate add-on appended for additional levels.

A historically contested NCCI edit barred separate billing of 63047 with 22633/22634 at the same interspace. As of July 2023, CMS deleted the NCCI PTP edits between 22633/22634 and 63052/63053, meaning laminectomy/facetectomy/foraminotomy performed at the same level as a combined interbody fusion can now be reported separately with those codes — no modifier required. The old edit pairing 63047 with 22630/22633 at the same interspace remains in effect.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.76
Practice expense RVU	2.61
Malpractice RVU	2.58
Total RVU	12.95
Medicare national rate	$432.54
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	$432.54

Common denial reasons

The recurring reasons claims for CPT 22634 get rejected.

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

Billing 22634 without primary code 22633 on the same claim — it is an add-on with a single approved parent code.
Units of 22634 exceed the number of additional interspaces documented in the operative report.
Reporting 63047 with 22633/22634 at the same interspace — the NCCI edit prohibiting this combination remains active; use 63052/63053 instead for same-level decompression.
Modifier 51 appended to 22634 — add-on codes are exempt from multiple-procedure reduction and should never carry modifier 51.
Missing or vague operative note that describes the approach as 'combined technique' without specifying both the posterior interbody and posterolateral components by name.

Frequently asked questions

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

01Can 22634 be used as an add-on to 22630 or 22612?

No. Per the NCCI Policy Manual, 22634 is an add-on exclusively to primary code 22633. If additional levels are performed under a different primary technique, report the appropriate primary code for the first interspace of that technique and its own add-on.

02Can I bill 63052 or 63053 at the same level as 22633/22634?

Yes, as of October 1, 2023. CMS deleted the NCCI PTP edits between 22630/22632/22633/22634 and 63052/63053. These code pairs can now be reported together without a bypass modifier when the decompressive work is documented separately.

03Does 22634 carry a global period?

22634 has a ZZZ global period, meaning it inherits the global period of the primary procedure it accompanies. All post-operative care rules follow the primary code — 22633 in this case.

04What happens if modifier 51 is appended to 22634?

Add-on codes are excluded from multiple-procedure payment reduction rules. Appending modifier 51 to 22634 is incorrect and can trigger a denial or a payment reduction that shouldn't apply. Leave modifier 51 off all add-on codes.

05Is modifier 22 ever appropriate on 22634?

Modifier 22 should only be appended to the primary procedure code — in this case, 22633. Attaching modifier 22 to the add-on code 22634 is not appropriate and is inconsistent with standard billing practice as reflected in AAPC forum guidance.

06Can two surgeons each bill 22634 using modifier 62?

Yes, when two surgeons perform distinct portions of the combined fusion as co-primary surgeons, both may report 22633 and 22634 with modifier 62. Each surgeon's operative note must document their specific contribution to each 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 specific interspaces and segments treated, the combined surgical approach by name, and the scope of disc space preparation versus any separate decompressive work at each level. That documentation directly maps operative note content to the unit count billed for 22634 and supports any co-billed decompression codes — preventing denials for mismatched units or unsupported code combinations.

See how Mira captures CPT 22634 documentation