Fusion · Spine

Add-on code for insertion of a pelvic fixation device during spinal instrumentation procedures, reported alongside a primary spine arthrodesis or fracture/dislocation code.

Verified May 8, 2026 · 5 sources ↓

Medicare: $317.64
Total RVUs: 9.51
Global, days
Region: Spine

Drawn from CMSAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Identify the specific pelvic anchor type used (iliac screw, S2-alar-iliac screw, or equivalent) and laterality (unilateral vs. bilateral).
Confirm the primary arthrodesis or fracture/dislocation CPT code being billed alongside 22848 — payer will cross-check NCCI-approved pairings.
Operative note must describe the pelvic fixation work as distinct from sacral instrumentation included in the primary instrumentation code.
Document the clinical indication driving extension of the construct to the pelvis (e.g., neuromuscular deformity, sacropelvic instability, long-segment fusion to S1).
If co-surgery, each surgeon's operative report must delineate their individual contribution to the pelvic fixation component.
For modifier 22, document the specific factors that made pelvic fixation significantly more difficult than typical (e.g., morbid obesity, severe deformity, revision construct).

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 62 Co-surgeons 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 22848 is an add-on code covering the insertion of a pelvic fixation device as part of a spinal instrumentation construct. It is never reported alone — the global period is ZZZ, meaning it inherits the global period of its primary procedure. Per the NCCI Policy Manual, codes 22840–22848 are reportable only with specific primary codes covering fracture, dislocation, or arthrodesis of the spine (22325–22327, 22548–22812). Billing 22848 with a primary code outside that approved list is an NCCI violation.

Pelvic fixation extends a spinal construct to the pelvis, typically using iliac screws, S2-alar-iliac (S2AI) screws, or similar anchors. Indications include long-segment fusions ending at the sacrum, high-grade spondylolisthesis, neuromuscular scoliosis, and pelvic/sacral trauma. The operative note must distinguish the pelvic fixation work from sacral screw placement, which is captured separately under the primary instrumentation code. Coding editors and auditors flag cases where the pelvic anchor type and bilateral placement are not explicitly named in the note.

Top billing specialties are Orthopedic Surgery, Neurosurgery, and General Surgery per the CMS Physician & Other Practitioners Public Use File. Because 22848 is an add-on code, modifier 51 is never appended. Modifier 62 (co-surgery) applies when two surgeons of different specialties each perform distinct portions of the construct and both bill 22848 with a supporting co-surgery report.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	5.84
Practice expense RVU	1.93
Malpractice RVU	1.74
Total RVU	9.51
Medicare national rate	$317.64
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	$317.64

Common denial reasons

The recurring reasons claims for CPT 22848 get rejected.

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

Billed with a primary code outside the NCCI-approved list (22325–22327, 22548–22812) — automatic bundling denial.
Operative note does not distinguish pelvic fixation from sacral screw placement, making the add-on service indistinguishable from the primary instrumentation.
Modifier 51 incorrectly appended — 22848 is an add-on code and modifier 51 is never appropriate here.
Co-surgery billed without separate operative reports from each surgeon documenting their distinct roles.
Payer applies trauma-specific LCD criteria and the documentation does not support the pelvic/sacral injury classification required for that indication.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can 22848 be billed without a primary spine code?

No. CPT 22848 has a ZZZ global period, making it an add-on code that must accompany an approved primary procedure. Per NCCI, the only allowable primary codes are 22325–22327 and 22548–22812. Submitting 22848 alone will result in rejection.

02Does bilateral pelvic fixation get billed twice?

Generally no — 22848 covers the pelvic fixation device insertion regardless of whether one or two sides are instrumented. Document bilateral placement in the operative note, but do not append modifier 50 or bill two units without explicit payer guidance authorizing it.

03Is modifier 51 ever appropriate on 22848?

Never. Add-on codes are exempt from modifier 51 by CPT convention. Appending modifier 51 to 22848 can trigger a payment reduction that shouldn't apply and may flag the claim for review.

04How does co-surgery work for 22848?

When two surgeons from different specialties each perform a distinct portion of the pelvic fixation, both bill 22848 with modifier 62. Each surgeon must submit a separate operative report describing their specific contribution. The payer splits the allowable between the two surgeons.

05What is the difference between S2AI screw placement and iliac screw placement for coding purposes?

Both are captured under 22848 — the code is device-type agnostic. What matters for documentation is that the note names the anchor type and confirms the fixation extended to the pelvis, not just the sacrum. Audit teams use that language to validate the add-on code rather than bundling it into the primary instrumentation.

06Can 22848 be billed for trauma cases involving sacropelvic dissociation?

Yes, provided the primary code is within the approved NCCI list (22325–22327 for fracture/dislocation). The operative note must document the injury pattern and justify the pelvic fixation. Some MACs have LCDs with additional criteria for trauma indications — verify with your MAC before billing.

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 pelvic anchor type (iliac vs. S2AI), laterality, and the clinical rationale for extending the construct to the pelvis directly from surgeon dictation. It flags when the note conflates pelvic fixation with sacral screw placement — the most common documentation gap that causes payers to deny 22848 as unbundled from the primary instrumentation code.

See how Mira captures CPT 22848 documentation