Fusion · Spine

22861

Revision or replacement of a previously implanted cervical total disc arthroplasty, performed via an anterior approach at a single interspace.

Verified May 8, 2026 · 6 sources ↓

Medicare
$2,248.88
Total RVUs
67.33
Global, days
90
Region
Spine
Drawn from CMSHcaAAOSPayerprice

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 cervical interspace revised (e.g., C5-6, C6-7) — generic 'cervical level' is insufficient for audit purposes
  • Imaging studies (CT or MRI) documenting the failure mode of the primary device: migration, subsidence, wear, osteolysis, or heterotopic ossification
  • Prior surgical history confirming a total disc arthroplasty was previously placed at the same level — include original operative report or reference to prior implant records
  • Anterior surgical approach explicitly documented by name in the operative note; don't just note 'standard anterior approach'
  • Implant documentation: manufacturer, model, and lot number of both the removed and replacement device, per Joint Commission and payer implant log requirements
  • Pre-authorization approval number recorded in the billing record before claim submission
  • Neurologic examination findings pre- and post-operatively supporting the clinical indication for revision

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22861 covers the anterior surgical revision or replacement of a failed or malpositioned cervical artificial disc at one interspace. This is a high-complexity spinal procedure — the surgeon must re-enter the anterior cervical corridor, remove or reposition the existing prosthesis, address any subsidence, osteolysis, or migration, and implant a new device or perform definitive revision. The work substantially exceeds a primary disc replacement, which is why RVUs are significantly higher than the primary insertion codes.

The 90-day global period begins on the day of surgery. All routine post-op visits, wound checks, and management of expected recovery are bundled. If the patient presents during the global with a new, unrelated problem, append modifier 24 to the E/M. If the surgeon decided on this revision at a major E/M visit the day before or day of surgery, append modifier 57 to that E/M to keep it separately payable.

Pre-authorization is required by many payers — including some state Medicaid programs (e.g., Washington Medicaid requires prior authorization via clinical review for CPT 22856 and 22861). Document medical necessity explicitly: failed primary arthroplasty with imaging evidence of device failure, migration, subsidence, or adjacent segment deterioration. Missing or thin pre-auth documentation is a leading cause of post-payment recoupment on this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU32.53
Practice expense RVU21.07
Malpractice RVU13.73
Total RVU67.33
Medicare national rate$2,248.88
Global period90 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

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$2,248.88
HOPD (APC 5116)
Hospital outpatient department
$17,913.59
ASC (PI J8)
Ambulatory surgical center (freestanding)
$11,692.17

Common denial reasons

The recurring reasons claims for CPT 22861 get rejected.

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

  • Missing or expired prior authorization — many commercial and Medicaid payers require pre-auth for cervical disc revision before the date of service
  • Insufficient medical necessity documentation: claim submitted without imaging evidence of device failure or clinical justification distinguishing revision from primary arthroplasty
  • Wrong interspace or laterality discrepancy between the operative note, the claim, and the imaging report
  • Global period conflict: claim for a post-op visit billed without modifier 24 or 57 is auto-denied as bundled under the 90-day global of the primary procedure
  • Duplicate procedure flag when both 22861 and a primary arthroplasty code appear on the same date without appropriate modifier justification

Frequently asked questions

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

01What is the difference between CPT 22861 and CPT 22856?
22856 is the primary (first-time) cervical total disc arthroplasty at a single interspace. 22861 is the revision or replacement of a previously implanted device at the same level. Use 22861 any time the surgeon is returning to a level where a disc arthroplasty already exists — even if the prior implant was placed by a different surgeon.
02Can 22861 and 22862 be billed together?
22862 covers lumbar total disc arthroplasty revision. If a cervical and lumbar revision are performed in the same operative session, billing both is anatomically appropriate — different spinal regions. Append modifier 51 to the lower-valued code and document each level separately in the operative note.
03Does 22861 require prior authorization?
Yes, for most payers. Washington State Medicaid explicitly requires clinical review prior authorization for 22861. Most commercial insurers treat cervical disc revision as a high-cost, high-scrutiny procedure. Submit the prior auth request with imaging evidence of device failure before scheduling the case.
04If the patient returns to the OR during the 90-day global for a complication related to the revision, which modifier applies?
Modifier 78 — unplanned return to the OR for a procedure related to the original surgery, during the global period. Do not use modifier 79 (that is for an unrelated procedure). Modifier 78 reimburses at the intraoperative value only; the post-op period is not reset.
05Can modifier 22 be used on 22861 if the revision was unusually complex?
Yes. If the revision required substantially greater work — severe scarring, hardware extraction difficulty, neurovascular mobilization beyond the norm — document the specific circumstances in the operative note and append modifier 22. The note must quantify the additional time and difficulty; auditors reject modifier 22 claims that simply state 'difficult case.'
06What is the site-of-service difference between billing 22861 in a hospital versus an ASC?
The HOPD payment is higher than the ASC payment for this code. The physician's professional fee is the same regardless of site, but the facility fee differs substantially. Some high-acuity cervical revision cases may not be approved for ASC setting by payers — confirm with the payer before scheduling outpatient.
07Is a co-surgeon allowed on 22861, and how is that billed?
If two surgeons of different specialties each perform distinct portions of the revision (e.g., a spine surgeon and a vascular access surgeon), both may bill 22861 with modifier 62. Each operative note must document that surgeon's specific role. A surgical assistant bills with modifier 80 or AS depending on their credential.

Sources & references

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

  1. 01CMS Physician Fee Schedule 2026
  2. 02
    cms.gov
    https://www.cms.gov/medicare/regulations-guidance/physician-self-referral/list-cpt-hcpcs-codes
  3. 03
    hca.wa.gov
    https://www.hca.wa.gov/assets/billers-and-providers/physician-related-services-bi-07012012.pdf
  4. 04
    cms.gov
    https://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf
  5. 05
    aaos.org
    https://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
  6. 06
    payerprice.com
    https://payerprice.com/rates/22861-CPT-fee-schedule

Mira AI Scribe

Mira's AI scribe captures the specific interspace revised, the approach by name, the failure mode of the prior device (migration, subsidence, osteolysis), implant removal confirmation, and the replacement device details from dictation. That prevents the most common audit flag on 22861: an operative note that describes a generic anterior cervical case without distinguishing revision work from primary implantation — a distinction that directly defends the code and supports medical necessity on pre-auth reviews.

See how Mira captures CPT 22861 documentation

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