Revision of a lumbar total disc replacement at one level through an anterior approach, including removal of the old device and placement of a new one.
- Medicare
- $2,267.92
- Work RVU
- 31.81
- Global, days
- 90
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Imaging showing failure, migration, or subsidence of the existing disc
- Level treated and device removed and implanted (with stickers)
- Approach and scar tissue findings during revision exposure
- Co-surgeon notes describing each surgeon's portion when 62 is used
- Prior authorization number
- Patient age and the conservative care tried before revision
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
22862 is for going back into a lumbar artificial disc at a single level and replacing it with a new device. The code includes removing the failed or migrated implant, preparing the endplates again, and seating the new disc. If the surgeon removes the disc and converts to a fusion instead, use the removal code 22865 plus the fusion codes, not 22862.
It carries a 90-day global. Medicare lists it as status R, meaning restricted coverage. The national coverage determination for lumbar artificial discs excludes patients over 60, and MACs decide coverage case by case for younger patients. Most commercial payers require prior authorization with imaging that shows device failure, subsidence, or migration.
Anterior lumbar revisions often involve an access surgeon. When a vascular or general surgeon handles the exposure, check the co-surgeon indicator on the fee schedule and the payer's own policy before using modifier 62. If co-surgery is allowed, both surgeons append 62 to the same code and each writes a note covering only their part. Scar from the first anterior approach makes revision exposure harder, so the note should describe what the access surgeon found.
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 (31.81) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (67.9) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 31.81 |
| Practice expense RVU | 22.64 |
| Malpractice RVU | 13.45 |
| Total RVU | 67.9 |
| Medicare national rate | $2,267.92 |
| 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 | $2,267.92 |
HOPD (APC 5116) Hospital outpatient department | $17,913.59 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $13,933.19 |
Common denial reasons
The recurring reasons claims for CPT 22862 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medicare patient over 60, which falls outside coverage for lumbar disc arthroplasty
- No prior authorization
- Co-surgeon billing without separate notes or payer co-surgery allowance
- Converted to fusion but billed as revision replacement
- Imaging did not support device failure
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01What is the global period for CPT 22862?
02Does Medicare cover lumbar disc replacement revision?
03Can an access surgeon bill with 22862?
04What code is used if the disc is removed and the level is fused?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the failure findings, devices removed and placed, and each surgeon's role, which is what reviewers ask for on a lumbar disc revision.
See how Mira captures CPT 22862 documentation