Surgical · Spine

Removal of a previously implanted single-level cervical total disc arthroplasty device at one interspace.

Verified May 8, 2026 · 6 sources ↓

Medicare: $2,021.09
Total RVUs: 60.51
Global, days: 90
Region: Spine

Drawn from CMSAAPCCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the cervical interspace level (e.g., C5-C6) in the operative report header and body
State the indication for removal — device failure, migration, infection, adjacent-segment disease, or other named diagnosis
Document implant details: manufacturer, device type, and lot/serial number when available
Describe the surgical approach (anterior cervical) and confirm single-level explantation scope
Record intraoperative findings including endplate condition, bone loss, and any hardware or soft-tissue complications encountered
If a fusion or reconstruction follows at the same level, document that as a separate operative step with its own CPT

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 58 Staged or related 62 Co-surgeons 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 22864 covers the surgical removal of an artificial disc prosthesis that was placed during a prior cervical total disc replacement procedure, addressed at a single interspace. This is a revision operation — it is not the index arthroplasty and not a fusion. The code is used when the implanted device must be taken out due to failure, migration, infection, adjacent-segment disease progression, or other indication requiring explantation.

The procedure carries a 90-day global period. All routine post-op management, dressing changes, and related E/M visits from the day before surgery through day 90 are bundled. A separate E/M or procedure billed within that window must carry modifier 24 (unrelated E/M), 25 (separate significant E/M same day, pre-op), 78 (unplanned return for a related procedure in the global), or 79 (unrelated procedure in the global) as appropriate.

If a fusion or other definitive reconstructive procedure is performed at the same interspace during the same operative session — which is common after device removal — code that separately and evaluate NCCI bundling rules. Fluoroscopy used intraoperatively is integral to the procedure and cannot be billed separately. Document the specific cervical level, the indication for removal, implant details (manufacturer, type), approach, and any intraoperative findings including bone or endplate condition.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	28.67
Practice expense RVU	19.72
Malpractice RVU	12.12
Total RVU	60.51
Medicare national rate	$2,021.09
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	$2,021.09
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 22864 get rejected.

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

Missing or vague indication — payer requires documented implant failure, migration, infection, or other specific cause for removal
Global period conflict — post-op visit or related procedure billed without required modifier (24, 78, or 79) within the 90-day window
Incorrect level specificity — operative note states 'cervical disc removal' without naming the interspace, triggering medical-necessity review
Bundling denial when fusion at the same level same day is billed without verifying NCCI PTP edit status and applying appropriate modifier
Fluoroscopy billed separately — it is integral to the procedure and will deny as unbundled

Frequently asked questions

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

01Can 22864 be billed when a fusion is performed at the same level during the same session?

Yes, but verify the NCCI PTP edit pairing between 22864 and the applicable fusion code. If the edit allows a modifier, append the appropriate modifier and ensure the operative note documents each procedure as a distinct surgical step.

02What modifier applies if a complication requires the patient to return to the OR within the 90-day global for a related procedure?

Use modifier 78 — unplanned return to the operating room for a procedure related to the original surgery during the global period. Do not use modifier 79, which is reserved for unrelated procedures.

03Is fluoroscopy separately billable with 22864?

No. Intraoperative fluoroscopy is integral to cervical spinal procedures including device removal. Billing it separately will trigger a bundling denial under NCCI policy.

04Does 22864 cover removal at more than one cervical interspace?

No. 22864 is a single-interspace code. If devices are removed at two separate cervical levels during the same session, report the code twice with modifier 51 and document each level distinctly in the operative note. Confirm payer policy on multiple-level billing.

05What ICD-10 diagnoses support medical necessity for 22864?

Common supporting diagnoses include mechanical complication of internal orthopedic prosthetic device (T84.x), adjacent-level degeneration, infection of spinal implant, and pseudarthrosis. The diagnosis must match the documented clinical indication in the operative note — mismatched codes are a primary denial driver.

06Can modifier 22 be appended to 22864 for unusually difficult explantation?

Yes, when the work is substantially greater than typical — for example, severe heterotopic ossification or implant migration with complex dissection. The operative note must detail the specific circumstances that increased operative time and complexity. Expect payer review and potential documentation request.

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 cervical interspace level, named indication for explantation, implant details, and intraoperative findings from dictation in real time. That prevents the most common denial trigger for 22864 — an operative note that omits the specific level or fails to document why the device required removal. If a same-day reconstruction is dictated, the scribe flags it for separate CPT assignment before the claim drops.

See how Mira captures CPT 22864 documentation