Fusion · Spine

Anterior spinal instrumentation placed across 2 to 3 vertebral segments; reported as an add-on to the primary spinal procedure code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $647.64
Total RVUs: 19.39
Global, days
Region: Spine

Drawn from CMSAAPCIsassScribd

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific vertebral levels instrumented (e.g., T10–T12) and confirm the segment count falls within the 2–3 range covered by this code.
Operative note must distinguish whether anterior fixation is independent of any interbody device's anchoring mechanism, or integral to it — this determines whether 22845 is separately reportable.
Specify the hardware type and approach (anterior thoracic, anterior lumbar, anterior cervical) by name; notes that reference only a 'standard approach' invite audit scrutiny.
Document the primary procedure code being performed in the same session, since 22845 is an add-on and cannot stand alone.
If modifier 59 is appended alongside 22853 or 22854, the note must clearly support that the instrumentation is unrelated to device anchoring.

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 59 Distinct service 62 Co-surgeons 76 Repeat, same physician

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

22845 is an add-on code (ZZZ global) for anterior spinal instrumentation — rods, screws, or plates anchored from the front of the spine — spanning 2 to 3 vertebral segments. It is never reported alone; it requires a primary procedure code such as a spinal fusion or vertebral body reconstruction. The ZZZ global means it inherits the global period of the primary procedure it accompanies.

The critical bundling distinction: report 22845 only when the anterior fixation is separate from and not integral to any biomechanical cage or interbody device being placed. When a device has integral instrumentation for its own anchoring (fixation that cannot be independently implanted), 22845 is not separately reportable. When fixation is placed that is independent of the device's anchoring mechanism, 22845 is appropriate — and may require modifier 59 to bypass NCCI edits when billed alongside 22853 or 22854, per NCCI policy clarified in 2017.

Segment count drives code selection across the 22845–22847 family: 22845 covers 2–3 segments, 22846 covers 4–7 segments, and 22847 covers 8 or more segments. Report only one unit of 22845 per operative session — the code is defined by segment range, not by the number of implants placed.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	11.64
Practice expense RVU	3.9
Malpractice RVU	3.85
Total RVU	19.39
Medicare national rate	$647.64
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	$647.64

Common denial reasons

The recurring reasons claims for CPT 22845 get rejected.

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

Billed without a primary procedure code — 22845 is an add-on code and will reject if submitted alone.
NCCI bundling edit with 22853 or 22854 triggers denial when modifier 59 is absent and the note does not distinguish independent fixation from integral device anchoring.
Reporting more than one unit when multiple implants are placed at the same 2–3 segment range — this code is reported once per operative session regardless of implant count.
Upcoding to 22846 or 22847 when only 2–3 segments are instrumented — payers cross-reference the operative report segment count against the code billed.
Insufficient documentation to support that the anterior instrumentation was independent of any biomechanical cage's integral fixation.

Frequently asked questions

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

01Can 22845 be reported as a standalone code?

No. 22845 is an add-on code with a ZZZ global period. It must be reported alongside a primary spinal procedure code — typically a fusion or vertebral reconstruction — in the same operative session.

02When should I use 22845 versus 22846 or 22847?

22845 is for anterior instrumentation spanning 2–3 vertebral segments. Use 22846 for 4–7 segments and 22847 for 8 or more. The operative note's documented level count drives the selection — do not estimate.

03Can 22845 be billed with 22853 or 22854?

Yes, but modifier 59 is required, and the operative note must clearly document that the anterior instrumentation is independent of the interbody device's anchoring mechanism — not just supplemental fixation that the device itself provides. NCCI edits bundle these codes absent that distinction.

04How many units of 22845 should be reported if multiple screws or rods are placed at the same 2–3 segment range?

One unit. The code is defined by the segment range instrumented, not by the number of implants. Billing multiple units for the same segment range will be downcoded or denied.

05Does 22845 have its own global period?

22845 carries a ZZZ global, which means it has no independent global period — it adopts the global period of the primary procedure it accompanies.

06Is modifier 62 (two surgeons) applicable to 22845?

It can be, when two surgeons each perform distinct components of the anterior instrumentation during a co-surgery arrangement. Both surgeons document their specific contributions, and each appends modifier 62 to their claim.

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 anterior approach, the specific vertebral levels instrumented, the hardware type placed, and whether fixation is independent of or integral to any interbody device — the exact language needed to support 22845 as a separately billable add-on. That prevents the most common denial trigger: an operative note that fails to distinguish independent anterior instrumentation from integral device anchoring, which causes automatic bundling with 22853 or 22854.

See how Mira captures CPT 22845 documentation