CPT 22804
Global 090 ActiveArthrd pst dfrm 13+ vrt sgm
CPT 22804 Billing & Documentation Guide
CPT code 22804 (Arthrd pst dfrm 13+ vrt sgm) is classified under Surgery (Musculoskeletal) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 36.56, a non-facility practice expense RVU of 19.62, and a malpractice RVU of 10.36, a total non-facility RVU of 66.54 and facility RVU of 66.54. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $2226.19, though rates vary from $1955.52 to $2778.45 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 22804, 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 22804 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 22804 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 22804
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 36.56 | 36.56 |
| Practice Expense RVU | 19.62 | 19.62 |
| Malpractice RVU | 10.36 | 10.36 |
| Total RVU | 66.54 | 66.54 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 22804
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 | $2227.99 | $2227.99 | $2145.61 - $2485.92 | 29 |
| Florida | $2552.26 | $2552.26 | $2367.72 - $2778.45 | 3 |
| Georgia | $2262.18 | $2262.18 | $2218.16 - $2306.2 | 2 |
| Illinois | $2519.89 | $2519.89 | $2360.3 - $2682.43 | 4 |
| Michigan | $2323.53 | $2323.53 | $2210.12 - $2436.94 | 2 |
| North Carolina | $2053.67 | $2053.67 | $2053.67 - $2053.67 | 1 |
| New York | $2480.57 | $2480.57 | $2086.96 - $2721.06 | 5 |
| Ohio | $2168.25 | $2168.25 | $2168.25 - $2168.25 | 1 |
| Pennsylvania | $2243.93 | $2243.93 | $2149.73 - $2338.13 | 2 |
| Texas | $2194.44 | $2194.44 | $2138.95 - $2357.79 | 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 22804
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 22804 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 0375T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 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 |
| 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 |
Frequently Asked Questions, CPT 22804
What does CPT code 22804 mean? +
CPT code 22804 represents: Arthrd pst dfrm 13+ vrt sgm. It's in the Surgery (Musculoskeletal) category with a global period of 090.
What is the Medicare reimbursement for CPT 22804? +
The 2026 Medicare national average non-facility payment for CPT 22804 is $2226.19. Rates range from $1955.52 to $2778.45 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 22804? +
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 22804? +
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 June 1, 2026.
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