CPT 62223
Global 090 ActiveEstablish brain cavity shunt
CPT 62223 Billing & Documentation Guide
CPT code 62223 (Establish brain cavity shunt) is classified under Surgery (Endocrine/Nervous/Eye/Ear) with a global period indicator of 090. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 13.7, a non-facility practice expense RVU of 11.87, and a malpractice RVU of 5.07, a total non-facility RVU of 30.64 and facility RVU of 30.64. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $1025.65, though rates vary from $885.37 to $1298.58 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 62223, 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 62223 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 62223 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 62223
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 13.7 | 13.7 |
| Practice Expense RVU | 11.87 | 11.87 |
| Malpractice RVU | 5.07 | 5.07 |
| Total RVU | 30.64 | 30.64 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 62223
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 | $1034.96 | $1034.96 | $990.67 - $1170.4 | 29 |
| Florida | $1185.04 | $1185.04 | $1091.14 - $1298.58 | 3 |
| Georgia | $1039.13 | $1039.13 | $1013.1 - $1065.16 | 2 |
| Illinois | $1165.9 | $1165.9 | $1084.25 - $1247.89 | 4 |
| Michigan | $1068.23 | $1068.23 | $1010.76 - $1125.7 | 2 |
| North Carolina | $935.71 | $935.71 | $935.71 - $935.71 | 1 |
| New York | $1151.82 | $1151.82 | $953.29 - $1272.75 | 5 |
| Ohio | $990.27 | $990.27 | $990.27 - $990.27 | 1 |
| Pennsylvania | $1031.08 | $1031.08 | $981.58 - $1080.58 | 2 |
| Texas | $1007.73 | $1007.73 | $975.7 - $1087.96 | 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 62223
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 62223 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0169T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 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 | 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 |
| 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 62223
What does CPT code 62223 mean? +
CPT code 62223 represents: Establish brain cavity shunt. It's in the Surgery (Endocrine/Nervous/Eye/Ear) category with a global period of 090.
What is the Medicare reimbursement for CPT 62223? +
The 2026 Medicare national average non-facility payment for CPT 62223 is $1025.65. Rates range from $885.37 to $1298.58 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 62223? +
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 62223? +
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 April 17, 2026.
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