22865

Rmvl tot arthrp 1ntrspc lmbr

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Code typePrimary
Payment statusRestricted coverage (R)
Global period90-day
Restricted coverage: Covered only in unusual circumstances; special instructions apply.

Pricing with Related Codes

Line
Qty
Global fee
Pro fee
Primary22865Rmvl tot arthrp 1ntrspc lmbr
1
$2,217.49
$2,217.49
Add-on0164TRemove lumb artif disc addl
0
$0.00/ unit
$0.00/ unit
Add-on20704Mnl prep&insj i-artic rx dev
0
$155.65/ unit
$128.59/ unit
Add-on20705Rmvl i-artic rx delivery dev
0
$128.26/ unit
$106.21/ unit
Whole procedure · 30.96 wRVU credited
$2,217.49
$2,217.49
How these numbers were computed
  • status=CThis code is not separately payable under the Physician Fee Schedule (status C) — amounts shown are $0.

RVU Breakdown

Component
Office
Facility
Work
30.96
30.96
Practice expense
22.35
22.35
Malpractice
13.08
13.08
Total RVU
66.39
66.39

Payment Policy & Modifiers

Allowed adjustments
Multiple procedure MPPRApplies
When billed with other procedures the same day: highest-valued paid 100%, the rest 50%. Add-on codes are exempt.
Assistant surgeon -80/81/8216%
Assistant at surgery (mod 80/81/82) is paid at 16% of the fee schedule amount.
Co-surgeons -6262.5% each
Co-surgeons (mod 62) are paid 62.5% of the fee each (125% total, split).
Team surgery -66By report
Team surgery is priced 'by report' — the contractor sets the amount; no standard percentage.
Not applicable to this code
Bilateral -50Prof / tech split

Global surgery package

Major surgery: payment covers the day before, the day of, and 90 days after. Of the total payment, 10% is attributed to pre-operative care, 71% to the procedure itself, and 19% to post-operative visits.