Surgical · Spine

Add-on code for total disc arthroplasty at a second lumbar interspace via anterior approach, reported alongside the primary single-interspace lumbar arthroplasty code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $344.36
Work RVU: 6.71
Global, days
Region: Spine

Drawn from CMSMedcentralMedtronicAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must identify the specific lumbar interspaces treated (e.g., L4-L5 and L5-S1), not just 'two levels'
Confirm anterior surgical approach is documented by name — retroperitoneal, transperitoneal, or equivalent
Document that discectomy was performed to prepare the interspace, not solely for decompression
Identify the artificial disc device implanted, including manufacturer and model, for implant log and payer requirements
Note that the second-level arthroplasty was performed in the same operative session as the primary 22857 procedure
Include pre-operative imaging (MRI/CT) confirming two-level degenerative disc disease to support medical necessity

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 78 Unplanned return — related 79 Unrelated during global XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

22860 is an add-on code used when a surgeon performs total disc arthroplasty at a second lumbar interspace during the same operative session as the primary procedure (22857). The anterior approach is used for both levels; the disc is excised and an artificial disc is implanted at the second interspace. Because this is an add-on code, it is never reported alone — it must accompany 22857 on the same claim.

This code replaced Category III code 0163T effective January 1, 2023, following FDA approval of lumbar disc replacement at two adjacent levels (L3–S1) in 2020. The transition to Category I status means more consistent payer coverage compared to the temporary tracking code it replaced. Bill one unit of 22857 and one unit of 22860 when two lumbar interspaces are treated.

The global period is ZZZ, meaning the code carries no global surgical period of its own — global period rules are governed by the primary procedure (22857). Medicare coverage is addressed under the Lumbar Artificial Disc Replacement LCD and its associated billing and coding article (A56390), which lists covered diagnoses and applicable bill types. Payers vary on coverage criteria; verify authorization requirements before surgery.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (6.71) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (10.31) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	6.71
Practice expense RVU	1.92
Malpractice RVU	1.68
Total RVU	10.31
Medicare national rate	$344.36
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	$344.36

Common denial reasons

The recurring reasons claims for CPT 22860 get rejected.

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

Submitted without the required primary procedure code 22857 — add-on codes cannot stand alone
Payer non-coverage: some commercial payers still limit lumbar TDA to single-level, requiring prior authorization for two-level
Missing or vague operative note that does not specify both interspace levels or the anterior approach
ICD-10-CM diagnosis code does not support two-level pathology or does not match payer's covered diagnosis list under LCD A56390
Procedure billed at ASC or HOPD facility where payer has not established a facility payment rate for this code

Frequently asked questions

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

01Can 22860 be billed without 22857?

No. 22860 is a add-on code and must always be reported with 22857 on the same claim. Submitting it as a standalone code will result in an automatic denial.

02What replaced 22860's predecessor code?

22860 replaced Category III code 0163T effective January 1, 2023. The upgrade to Category I followed FDA approval of two-level lumbar disc replacement in 2020, and it means more consistent payer reimbursement than the temporary tracking code it replaced.

03Does 22860 carry its own global period?

No. The global period is ZZZ, meaning 22860 has no independent global period. Post-operative care rules are governed by the primary procedure code 22857.

04Which modifier applies when two surgeons perform distinct portions of the two-level arthroplasty?

Modifier 62 applies when two surgeons of different specialties each perform distinct parts of the procedure. Both surgeons report 22857 and 22860 with modifier 62, and each operative note must document the surgeon's individual contribution.

05Is Medicare coverage automatic for 22860?

No. Medicare coverage is governed by the Lumbar Artificial Disc Replacement LCD and billing and coding article A56390. Coverage criteria include specific diagnosis requirements; verify the patient's ICD-10-CM codes map to covered diagnoses in that article before submitting.

06When is modifier 59 appropriate on 22860?

Use modifier 59 (or XS) when an NCCI edit bundles a separately performed service and documentation supports the distinct or separate-site nature of the second procedure. It is not a routine add-on to 22860 itself — apply it only when a specific NCCI conflict exists and documentation substantiates it.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the operative level pair (e.g., L4-L5 primary, L5-S1 second interspace), the named anterior approach, and device identification for each artificial disc from dictation. This prevents the most common audit flag: an operative note that documents two-level surgery without specifying which interspaces were treated or confirming the second level qualifies as arthroplasty rather than decompression-only discectomy.

See how Mira captures CPT 22860 documentation