CPT 22842
Global ZZZ ActiveInsert spine fixation device
CPT 22842 Billing & Documentation Guide
CPT code 22842 (Insert spine fixation device) is classified under Surgery (Musculoskeletal) with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 12.25, a non-facility practice expense RVU of 4.1, and a malpractice RVU of 4.01, a total non-facility RVU of 20.36 and facility RVU of 20.36. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $675.08, though rates vary from $581.61 to $890.45 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 22842, 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 22842 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 22842 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 22842
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 12.25 | 12.25 |
| Practice Expense RVU | 4.1 | 4.1 |
| Malpractice RVU | 4.01 | 4.01 |
| Total RVU | 20.36 | 20.36 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 22842
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 | $658.5 | $658.5 | $638 - $723.43 | 29 |
| Florida | $807.29 | $807.29 | $741.39 - $890.45 | 3 |
| Georgia | $700.68 | $700.68 | $690.97 - $710.38 | 2 |
| Illinois | $798.87 | $798.87 | $743.54 - $857.04 | 4 |
| Michigan | $726.27 | $726.27 | $685.41 - $767.13 | 2 |
| North Carolina | $622.52 | $622.52 | $622.52 - $622.52 | 1 |
| New York | $763.43 | $763.43 | $633.42 - $846.9 | 5 |
| Ohio | $669.2 | $669.2 | $669.2 - $669.2 | 1 |
| Pennsylvania | $690.16 | $690.16 | $661.45 - $718.87 | 2 |
| Texas | $670.65 | $670.65 | $652.62 - $732.72 | 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 22842
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 22842 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0228T | Column 1 (primary), can be billed with modifier | Yes | Anesthesia service included in surgical procedure |
| 0230T | Column 1 (primary), can be billed with modifier | Yes | 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 |
| 20650 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 22505 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 22840 | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 22840 | Column 1 (primary), can be billed with modifier | 9 | HCPCS/CPT procedure code definition |
Frequently Asked Questions, CPT 22842
What does CPT code 22842 mean? +
CPT code 22842 represents: Insert spine fixation device. It's in the Surgery (Musculoskeletal) category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 22842? +
The 2026 Medicare national average non-facility payment for CPT 22842 is $675.08. Rates range from $581.61 to $890.45 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 22842? +
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 22842? +
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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