Anterior lumbar total disc arthroplasty at a single interspace, including discectomy to prepare the interspace (not for decompression purposes).

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,568.84
Total RVUs: 46.97
Global, days: 90
Region: Spine

Drawn from CMSMedtronicMedcentralGuidelinesUhcprovider

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify the operative level(s) — e.g., L4-L5 — and confirm single interspace in the operative note
Document the anterior approach explicitly; vascular surgery co-access is common and should be noted
State that the discectomy was performed to prepare the interspace for implant placement, not for primary neural decompression
Record implant details: manufacturer, device name, lot number, and size per CMS implant documentation standards
Pre-op imaging (MRI or CT) confirming degenerative disc disease at the operative level with disc height loss or annular pathology
Document failure of conservative management (duration, modalities attempted) to support medical necessity for prior authorization and potential audit
If nerve root decompression was incidentally achieved, note it as secondary — do not code a separate decompression or it will conflict with the 22857 descriptor

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 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 8 cited references ↓

CPT 22857 covers a single-level lumbar total disc arthroplasty performed via an anterior approach. The surgeon removes the degenerated disc and prepares the endplates, then seats an artificial disc prosthesis into the interspace. The discectomy work here is preparatory — it creates the space for the implant, not a standalone decompression procedure. That distinction matters: the descriptor explicitly excludes decompression as the operative intent, which separates 22857 from codes where nerve root decompression is the primary driver.

For a second lumbar interspace performed in the same session, add +22860 — one unit of 22857 plus one unit of 22860. Do not report 22857 twice. 22857 carries a 90-day global period, so routine post-op management through day 90 is bundled. Anything unrelated billed during the global window needs modifier 24 or 25 on an E/M or modifier 79 on a surgical procedure.

Payer authorization requirements for lumbar disc arthroplasty are stricter than for most spine procedures. UnitedHealthcare, Carelon, and most commercial plans require prior authorization and have published medical necessity criteria — typically confirming single or two-level degenerative disc disease between L3 and S1, failure of conservative care, and absence of significant facet disease or osteoporosis. Obtain authorization before surgery and attach clinical documentation tying the operative plan to those criteria. Denials at the authorization stage are common when indications aren't documented explicitly in the pre-op notes.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	26.45
Practice expense RVU	14.89
Malpractice RVU	5.63
Total RVU	46.97
Medicare national rate	$1,568.84
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	$1,568.84
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$12,699.87

Common denial reasons

The recurring reasons claims for CPT 22857 get rejected.

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

Missing or expired prior authorization — most commercial and Medicare Advantage plans require it for lumbar arthroplasty
Medical necessity not established: pre-op notes lack documentation of conservative care failure or imaging correlation
Billing 22857 twice for a two-level case instead of 22857 plus add-on code +22860
Bundling conflict when a separate decompression code is appended — the descriptor for 22857 subsumes preparatory discectomy work
Global period violations: post-op E/M billed without modifier 24 or unrelated surgical procedure billed without modifier 79
Operative note says 'standard anterior approach' without specifying level, laterality of vascular retraction, or implant confirmation

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can I bill 22857 twice for a two-level lumbar disc replacement?

No. Bill one unit of 22857 for the primary interspace and add +22860 for the second interspace. Billing 22857 x2 will hit an MUE wall and deny.

02Is a separate decompression code billable with 22857?

Generally no. The 22857 descriptor includes discectomy work as part of interspace preparation. If you separately report a decompression code, payers and NCCI will bundle it. The exception is if decompression is performed at a clearly distinct interspace — then append modifier 59 or XS with supporting documentation showing separate levels.

03Can two surgeons each bill 22857 using modifier 62?

Yes, if two surgeons perform distinct components of the procedure — typically a vascular or general surgeon for anterior exposure and the spine surgeon for the arthroplasty itself. Both bill 22857-62. Each operative note must document the distinct role. Some payers require co-surgeon agreements on file.

04What modifier applies if the surgeon bills an E/M during the 90-day global period for an unrelated condition?

Use modifier 24 on the E/M to indicate it is unrelated to the arthroplasty. Document in the note that the visit addressed a condition separate from the lumbar disc replacement. Without modifier 24, the claim will deny as bundled into the global.

05Does 22857 require prior authorization from Medicare?

Traditional Medicare does not require prior authorization for 22857, but Medicare Advantage plans frequently do. Commercial payers almost universally require it. Carelon and UnitedHealthcare both publish formal medical necessity criteria for lumbar disc arthroplasty — confirm authorization before scheduling.

06How does 22857 differ from 22857 for cervical — is there a parallel code?

The cervical equivalent is 22856. The two codes have different descriptors: 22856 includes osteophytectomy and microdissection language; 22857 for lumbar does not include that language. Do not substitute one for the other based on anatomic region — use 22856 for cervical single-level and 22857 for lumbar single-level.

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 operative level (e.g., L4-L5), confirms anterior approach, records that discectomy was performed to prepare the interspace for implant placement rather than for decompression, and logs implant name, manufacturer, and size from dictation. This prevents the most common audit flag on 22857 — operative notes that omit the preparatory-versus-decompression distinction or leave the device documentation incomplete.

See how Mira captures CPT 22857 documentation