CPT CODES

CPT Code 22830

CPT code 22830 is for the exploration of spinal fusion, detailing the procedure for reviewing and assessing a spinal fusion surgery.

Table of Contents
What is CPT Code 22830
Does CPT 22830 Need a Modifier?
CPT Code 22830 Medicare Reimbursement
Are You Being Underpaid for 22830 CPT Code?
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What is CPT Code 22830

CPT code 22830 is for the exploration of a spinal fusion. This means that the procedure involves a detailed examination of a previously performed spinal fusion to assess its condition, check for any complications, or determine the success of the fusion.

Does CPT 22830 Need a Modifier?

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CPT Code 22830 Medicare Reimbursement

Medicare reimbursement for CPT code 22830, which pertains to the exploration of spinal fusion, is subject to specific guidelines and conditions. Generally, Medicare does reimburse for this procedure when it is deemed medically necessary. The reimbursement amount can vary based on several factors, including the geographic location of the service, the setting in which the procedure is performed (e.g., hospital outpatient department, ambulatory surgical center), and whether the provider is participating in Medicare.

As of the latest available data, the national average reimbursement rate for CPT code 22830 under the Medicare Physician Fee Schedule (MPFS) is approximately $1,200. However, this amount can fluctuate, so it is advisable to consult the most recent MPFS or contact your Medicare Administrative Contractor (MAC) for the precise reimbursement rate applicable to your specific circumstances.

For the most accurate and up-to-date information, healthcare providers should refer to the Medicare Fee Schedule Lookup Tool or consult with their billing department to ensure compliance with Medicare's billing and coding requirements.

Are You Being Underpaid for 22830 CPT Code?

Discover how MD Clarity's RevFind software can meticulously read your contracts and detect underpayments down to the CPT code level, including specific codes like 22830 for spinal fusion exploration. Schedule a demo today to see how RevFind can help you identify and address underpayments by individual payer, ensuring you receive the full reimbursement you deserve.

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