Fusion · Spine

Anterior cervical total disc arthroplasty at a second interspace level, performed during the same session as the primary-level procedure, including discectomy, end plate preparation, and osteophytectomy as needed.

Verified May 8, 2026 · 5 sources ↓

Medicare: $449.24
Total RVUs: 13.45
Global, days
Region: Spine

Drawn from CMSExcellusbcbsAAPC

Documentation requirements

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

Source · Editorial brief grounded in 5 cited references ↓

Operative note must identify both disc levels by name (e.g., C5-6 and C6-7) and confirm anterior approach for each.
Document discectomy, end plate preparation technique, and osteophytectomy performed at the second level.
Implant record including device name, manufacturer, and lot number for the second-level artificial disc.
Pre-operative imaging report (CT or MRI) confirming pathology at both operative levels, ideally from an independent radiologist.
Documentation of failed conservative treatment — type, duration, frequency, and patient response — to support medical necessity for the second level.
ICD-10 diagnosis codes linked to the second operative level (myelopathy M50.0x, radiculopathy M50.1x, or M54.12 as applicable).
Prior authorization confirmation and reference number for the second-level procedure, if payer-required.

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 22858 covers a second-level cervical total disc arthroplasty performed via anterior approach during the same operative session as the initial level (22856). The surgeon removes the degenerated disc, prepares the vertebral end plates, clears any osteophytes impinging on the nerve root or spinal cord, and implants a mobile artificial disc designed to preserve segmental motion. Both levels are addressed through the same anterior exposure.

22858 is an add-on code — it cannot be billed without the primary code 22856 on the same claim. The ZZZ global period means it inherits the global package of the primary procedure. Two-level cervical disc arthroplasty is subject to rigorous prior authorization scrutiny: payers typically require documented failure of conservative treatment, qualifying imaging (CT or MRI read by an independent radiologist), specific ICD-10 diagnoses (M50.0x myelopathy, M50.1x radiculopathy, M54.12), and confirmation of appropriate patient selection criteria before authorizing the second level.

Medicare coverage for cervical artificial disc replacement is governed by CMS Billing and Coding Article A57021. Payer policies vary significantly on two-level coverage — some commercial plans (e.g., Excellus BCBS) have explicit criteria for the second level that differ from Medicare. Confirm coverage and medical necessity documentation requirements before surgery for every payer, not just Medicare.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.19
Practice expense RVU	2.72
Malpractice RVU	2.54
Total RVU	13.45
Medicare national rate	$449.24
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	$449.24

Common denial reasons

The recurring reasons claims for CPT 22858 get rejected.

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

Missing primary code 22856 on the same claim — 22858 cannot stand alone as an add-on code.
Medical necessity denied for second level due to insufficient documentation of conservative treatment failure at that specific level.
Payer policy excludes two-level cervical arthroplasty as investigational or non-covered without explicit prior authorization.
ICD-10 diagnosis does not map to the second operative level or does not meet payer-specific coverage criteria.
Prior authorization obtained only for one level; second-level add-on not separately authorized by the payer.

Frequently asked questions

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

01Can 22858 be billed without 22856?

No. 22858 is a CPT add-on code and must always be reported with 22856 as the primary procedure on the same claim. Submitting 22858 alone will result in an automatic denial.

02What is the global period for 22858?

ZZZ — meaning 22858 has no independent global period and rolls into the global package of the primary procedure (22856). Post-op visits are governed by 22856's global assignment.

03Does modifier 51 apply to 22858?

Modifier 51 is generally not appended to add-on codes. Most payers recognize 22858 as an add-on by definition. Check your specific payer's rules, but do not routinely append modifier 51 to this code.

04Is two-level cervical disc arthroplasty covered by Medicare?

Medicare coverage is addressed in CMS Billing and Coding Article A57021. Coverage is subject to specific diagnosis and medical necessity criteria. Verify LCD applicability in your MAC jurisdiction before assuming coverage.

05What ICD-10 codes support 22858?

The second operative level needs its own supporting diagnosis. Commonly used codes include the M50.0x cervical myelopathy range, M50.1x cervical radiculopathy range, and M54.12 for cervical radiculopathy. The diagnosis must correspond to the specific vertebral level treated.

06Do commercial payers cover two-level cervical arthroplasty the same way Medicare does?

No. Commercial payer policies vary significantly. Some plans impose additional conservative treatment requirements or limit coverage to single-level procedures. Obtain prior authorization for each level explicitly and confirm the authorization covers both 22856 and 22858 before scheduling.

07Is fluoroscopy separately billable with 22858?

Intraoperative fluoroscopy (76000 or 77002) billing with cervical arthroplasty codes is payer-dependent and subject to NCCI bundling review. Some payers bundle it; others allow separate billing with modifier 59 or XS and supporting documentation. Check current NCCI PTP edits before appending.

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 second operative level by name (e.g., C5-6), the anterior approach, discectomy and end plate prep performed at that level, osteophytes removed, and the implant details from dictation. It flags when the primary-level code 22856 is not paired on the claim and prompts for the ICD-10 diagnosis tied specifically to the second level — the two most common triggers for same-day denials on add-on spine codes.

See how Mira captures CPT 22858 documentation