How much does Medicare pay for CPT 22216?

Medicare allowed an average of $276.84 per service and paid $220.90 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1468.21, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 22216?

Incision or removal of spine bone segment, each additional segment. It was billed 7,790 times to 3,405 Medicare beneficiaries by 163 providers in 2024.

Which specialty bills 22216 most?

Orthopedic Surgery, with 3,973 services from 80 clinicians. Next are Neurosurgery, Physician Assistant, Nurse Practitioner.

CPT 22216

Incision or removal of spine bone segment, each additional segment

$276.84Medicare-allowed amount per service, averaged across 7,790 services

Providers submitted

$1468.21

Asking price, not received

Medicare allowed

$276.84

The fee schedule figure

Medicare paid

$220.90

Balance is patient coinsurance

Providers submitted an average of $1468.21 for this code and Medicare allowed $276.84 — 5.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $220.90 (80%); the rest is the patient’s coinsurance and deductible.

Services: 7,790
Beneficiaries: 3,405
Providers billing it: 163
Total allowed: $2,156,584

What Medicare pays for CPT 22216

Across 7,790 services billed by 163 providers to 3,405 beneficiaries, Medicare allowed an average of $276.84 per service. That is 2.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 22216

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	3,973	1,637	$330.26	80
Neurosurgery	2,417	1,015	$316.16	49
Physician Assistant	1,134	646	$47.84	29
Nurse Practitioner	194	76	$48.18	3
General Surgery	72	31	$232.00	2

22216 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	2,823	$254.68	$201.90	41
Texas	689	$282.79	$227.06	16
Colorado	478	$269.28	$214.09	12
Florida	471	$358.11	$255.18	9
Arizona	393	$269.04	$223.50	7
Illinois	355	$398.41	$270.89	11
North Carolina	256	$306.59	$260.24	6
New York	243	$332.48	$220.85	4
Maryland	223	$375.55	$270.79	6
Massachusetts	217	$257.92	$198.77	6
Michigan	211	$279.00	$216.15	6
Oklahoma	205	$214.88	$183.02	5
Georgia	184	$241.39	$190.35	3
Tennessee	159	$234.63	$208.07	5
Ohio	134	$228.67	$182.65	3
Virginia	110	$281.57	$241.44	3
Missouri	105	$150.72	$122.76	3
Oregon	95	$257.81	$218.99	2
Indiana	63	$216.02	$198.31	3
Nevada	56	$56.61	$45.14	1
District of Columbia	55	$416.96	$280.11	1
Rhode Island	53	$275.49	$230.46	1
Nebraska	52	$297.83	$282.14	2
Alaska	43	$224.78	$146.05	2
Louisiana	41	$203.39	$168.70	2
Minnesota	36	$329.81	$280.07	1
Iowa	24	$312.46	$280.58	1
Utah	16	$342.02	$280.96	1

Related codes

22214Incision or removal of lower spine bone segment$586.26

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.