CPT 22505
Global 010 ActiveManipulation of spine
CPT 22505 Billing & Documentation Guide
CPT code 22505 (Manipulation of spine) is classified under Surgery (Musculoskeletal) with a global period indicator of 010. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.82, a non-facility practice expense RVU of 2, and a malpractice RVU of 0.78, a total non-facility RVU of 4.6 and facility RVU of 4.6. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $154.05, though rates vary from $131.59 to $196.22 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 22505, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 22505 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
10-day global period (minor procedure: pre-op day + procedure + 10 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 22505 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 22505
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.82 | 1.82 |
| Practice Expense RVU | 2 | 2 |
| Malpractice RVU | 0.78 | 0.78 |
| Total RVU | 4.6 | 4.6 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 22505
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $156.14 | $156.14 | $149 - $177.77 | 29 |
| Florida | $178.53 | $178.53 | $163.81 - $196.22 | 3 |
| Georgia | $155.78 | $155.78 | $151.43 - $160.13 | 2 |
| Illinois | $175.34 | $175.34 | $162.5 - $188.14 | 4 |
| Michigan | $160.19 | $160.19 | $151.19 - $169.18 | 2 |
| North Carolina | $139.76 | $139.76 | $139.76 - $139.76 | 1 |
| New York | $173.62 | $173.62 | $142.57 - $192.49 | 5 |
| Ohio | $148.04 | $148.04 | $148.04 - $148.04 | 1 |
| Pennsylvania | $154.62 | $154.62 | $146.73 - $162.51 | 2 |
| Texas | $151.09 | $151.09 | $145.78 - $163.46 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 22505
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 22505 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 00640 | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0213T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0216T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0228T | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0230T | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0333T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0464T | Column 1 (primary), can be billed with modifier | No | Standards of medical/surgical practice |
| 0596T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0597T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 22505
What does CPT code 22505 mean? +
CPT code 22505 represents: Manipulation of spine. It's in the Surgery (Musculoskeletal) category with a global period of 010.
What is the Medicare reimbursement for CPT 22505? +
The 2026 Medicare national average non-facility payment for CPT 22505 is $154.05. Rates range from $131.59 to $196.22 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 22505? +
Surgery codes commonly use modifier 22 (increased procedural services), 50 (bilateral), 51 (multiple procedures), 52 (reduced services), 58/78/79 (staged, unplanned return, unrelated within global), 62 (co-surgeons), 80/82 (assistant surgeon), and 59 or the X{EPSU} subset for distinct procedural service.
What bundling edits apply to CPT 22505? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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