CPT 22630
Global 090 ActiveArthrd pst tq 1ntrspc lum
CPT 22630 Billing & Documentation Guide
CPT code 22630 (Arthrd pst tq 1ntrspc lum) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 21.54, a non-facility practice expense RVU of 15.81, and a malpractice RVU of 7.88, a total non-facility RVU of 45.23 and facility RVU of 45.23. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1510.54, though rates vary from $1306.35 to $1934.8 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 22630, 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 22630 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
90-day global period (major surgery: 1 day pre-op + procedure + 90 days post-op)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 22630 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 22630
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 21.54 | 21.54 |
| Practice Expense RVU | 15.81 | 15.81 |
| Malpractice RVU | 7.88 | 7.88 |
| Total RVU | 45.23 | 45.23 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 22630
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 | $1512.82 | $1512.82 | $1451.52 - $1701.14 | 29 |
| Florida | $1761.64 | $1761.64 | $1619.88 - $1934.8 | 3 |
| Georgia | $1539.23 | $1539.23 | $1504.23 - $1574.23 | 2 |
| Illinois | $1735.19 | $1735.19 | $1612.96 - $1859.24 | 4 |
| Michigan | $1585.76 | $1585.76 | $1498.73 - $1672.79 | 2 |
| North Carolina | $1380.33 | $1380.33 | $1380.33 - $1380.33 | 1 |
| New York | $1700.52 | $1700.52 | $1406.15 - $1882.13 | 5 |
| Ohio | $1466.89 | $1466.89 | $1466.89 - $1466.89 | 1 |
| Pennsylvania | $1524.53 | $1524.53 | $1452.95 - $1596.12 | 2 |
| Texas | $1487.77 | $1487.77 | $1444.51 - $1611.74 | 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 22630
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 22630 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0195T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 0202T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 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 | Standards of medical/surgical practice |
| 0230T | Column 1 (primary), can be billed with modifier | No | Anesthesia service included in surgical procedure |
| 0275T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 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 |
| 0566T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 22630
What does CPT code 22630 mean? +
CPT code 22630 represents: Arthrd pst tq 1ntrspc lum. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 22630? +
The 2026 Medicare national average non-facility payment for CPT 22630 is $1510.54. Rates range from $1306.35 to $1934.8 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 22630? +
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 22630? +
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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