Fusion · Spine

Open insertion of an interlaminar or interspinous process stabilization/distraction device at a single lumbar level, performed with open decompression, without spinal fusion.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,012.05
Total RVUs: 30.3
Global, days: 90
Region: Spine

Drawn from HealthCMSAAPCCgsmedicare

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 explicitly name the open decompression performed (e.g., laminectomy, laminotomy, foraminotomy) — 'decompression performed' alone is insufficient for audit defense.
Identify the specific lumbar level(s) treated (e.g., L4-L5) with radiographic or intraoperative imaging confirmation.
Document that no fusion was performed and the clinical rationale for choosing an IPD over arthrodesis.
Record the device name, manufacturer, and lot/serial number per implant documentation requirements.
Pre-operative imaging (MRI or CT) demonstrating lumbar stenosis or spondylolisthesis supporting medical necessity.
Conservative treatment history demonstrating failure of non-operative management prior to surgical intervention.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 50 Bilateral procedure 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 80 Assistant surgeon LT Left side RT Right side XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22867 covers open placement of an interlaminar or interspinous process distraction (IPD) device at one lumbar level, anchored to the spinous processes of adjacent vertebrae, combined with open neural decompression. The device restricts segmental motion and distracts the neural foramina to relieve pressure on lumbar nerve roots. No fusion is performed — the vertebrae remain unfused, which distinguishes this code from arthrodesis-based procedures in the 22600s.

The code includes image guidance when used, so you cannot separately bill fluoroscopy or navigation performed as part of device placement. The 90-day global period swallows all routine post-op visits, wound checks, and minor complications managed in the office. Anything unrelated to the original procedure billed during that window requires modifier 24 or 79. A return to the OR for a related complication — e.g., device migration — bills with modifier 78.

Code 22868 is the add-on for a second lumbar level; it lists separately in addition to 22867. If decompression is not performed, use 22869 (single level) or 22870 (add-on second level) instead. Conflating the decompression and non-decompression families is a leading cause of medical necessity audit flags, since the documentation must affirmatively describe the open decompression to support 22867.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	14.63
Practice expense RVU	11.34
Malpractice RVU	4.33
Total RVU	30.3
Medicare national rate	$1,012.05
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	$1,012.05
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,800.05

Common denial reasons

The recurring reasons claims for CPT 22867 get rejected.

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

Medical necessity denial when pre-op imaging and conservative treatment failure are not documented in the record.
Upcoding flag when operative note describes only indirect or percutaneous decompression — 22867 requires open decompression; without it, correct code is 22869.
Bundling denial when fluoroscopy or image guidance is billed separately, since image guidance is included in 22867.
Global period denial when post-op office visits are billed without modifier 24 during the 90-day global window.
Add-on code 22868 denied when submitted without the primary code 22867 on the same claim.

Frequently asked questions

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

01What is the difference between CPT 22867 and 22869?

22867 requires open decompression performed at the same operative session as device insertion. 22869 covers IPD insertion at a single lumbar level without open decompression. Using 22867 when no open decompression was documented is a common audit finding that results in downcoding to 22869.

02Can I bill 22868 on the same claim as 22867?

Yes. 22868 is the add-on code for a second lumbar level treated with open decompression and IPD insertion. It must be listed in addition to 22867 and cannot be reported as a standalone code.

03Is image guidance separately billable with 22867?

No. Image guidance is bundled into 22867 by CPT convention. Billing fluoroscopy or navigation separately for the device placement will trigger an NCCI bundling denial.

04How does the 90-day global period affect post-op billing?

All routine post-op visits, wound management, and office services related to the procedure are included through day 90. Bill modifier 24 on E/M services for unrelated conditions, and modifier 79 for an unrelated surgical procedure performed by the same surgeon during the global period. An unplanned return to the OR for a related complication (e.g., device migration, wound dehiscence) uses modifier 78.

05When does modifier 22 apply to CPT 22867?

Modifier 22 is appropriate when the procedure required substantially more work than typical — for example, severe obesity, prior lumbar surgery causing significant scar tissue, or unusually complex anatomy. The operative note must describe the specific factors that increased complexity, and you should attach a cover letter to the claim. Expect payer requests for records.

06Can CPT 22867 be billed with a lumbar fusion code on the same date?

No. 22867 is defined as insertion without fusion. If fusion is performed at the same level on the same date, the appropriate fusion code family (e.g., 22612, 22630) governs, and billing 22867 alongside it would misrepresent the procedure. If fusion is performed at a different level on the same date, modifier 59 or XS may apply — verify against current NCCI PTP edits before submitting.

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 specific decompression technique performed (laminectomy, laminotomy, foraminotomy), the lumbar level treated, device details, and the explicit statement that no fusion was performed — directly from surgeon dictation. This prevents the most common audit trigger for 22867: an operative note that documents device insertion but omits a named open decompression, which forces a downcode to 22869 on review.

See how Mira captures CPT 22867 documentation