How much does Medicare pay for CPT 22551?

Medicare allowed an average of $1377.46 per service and paid $1097.62 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7806.16, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 22551?

Fusion of upper spine bone with removal of disc and release of spinal cord or nerve, 1 disc. It was billed 21,828 times to 21,746 Medicare beneficiaries by 1,272 providers in 2024.

Does 22551 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1032.12 in an office setting and $1378.06 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 22551 most?

Neurosurgery, with 8,429 services from 480 clinicians. Next are Orthopedic Surgery, Physician Assistant, Nurse Practitioner.

CPT 22551

Fusion of upper spine bone with removal of disc and release of spinal cord or nerve, 1 disc

$1377.46Medicare-allowed amount per service, averaged across 21,828 services

Providers submitted

$7806.16

Asking price, not received

Medicare allowed

$1377.46

The fee schedule figure

Medicare paid

$1097.62

Balance is patient coinsurance

Providers submitted an average of $7806.16 for this code and Medicare allowed $1377.46 — 5.7× 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 $1097.62 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1032.12
Hospital / facility: $1378.06

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 38 services were billed in an office setting and 21,790 in a facility.

Services: 21,828
Beneficiaries: 21,746
Providers billing it: 1,272
Total allowed: $30,067,197

What Medicare pays for CPT 22551

Across 21,828 services billed by 1,272 providers to 21,746 beneficiaries, Medicare allowed an average of $1377.46 per service. 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 22551

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurosurgery	8,429	8,399	$1579.20	480
Orthopedic Surgery	5,802	5,776	$1579.04	351
Physician Assistant	5,285	5,269	$220.83	318
Nurse Practitioner	1,319	1,312	$217.79	74
Ambulatory Surgical Center	729	727	$8036.39	34
Otolaryngology	130	130	$1000.67	7
Neurology	49	49	$1426.20	3
General Surgery	24	23	$1152.56	1
Osteopathic Manipulative Medicine	17	17	$1591.99	1
Certified Clinical Nurse Specialist	16	16	$232.46	1
Physical Medicine and Rehabilitation	16	16	$255.03	1
Cardiology	12	12	$1589.94	1

22551 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
Florida	2,442	$1288.44	$933.67	130
Texas	2,418	$1303.03	$1023.10	134
California	1,253	$1172.05	$889.32	78
Georgia	847	$1399.15	$1126.58	50
Virginia	837	$1203.63	$969.99	44
Louisiana	811	$1323.88	$1114.05	42
Maryland	795	$1727.50	$1302.92	43
North Carolina	788	$1341.80	$1133.89	40
South Carolina	779	$1378.62	$1168.64	51
Tennessee	771	$1375.04	$1229.79	44
Alabama	687	$1246.73	$1093.77	41
Oklahoma	685	$1067.58	$893.88	41
Arizona	684	$1219.25	$986.96	40
Illinois	623	$1247.56	$913.42	37
Ohio	548	$2033.90	$1679.28	32
Mississippi	478	$2454.95	$2194.38	22
Missouri	455	$1318.82	$1038.17	31
New York	445	$1709.71	$1241.47	33
Indiana	406	$1048.18	$927.13	28
Colorado	402	$1272.48	$1003.29	26
Kansas	391	$991.30	$847.46	20
Michigan	384	$1513.15	$1104.36	26
Pennsylvania	370	$1369.16	$1047.16	26
Arkansas	347	$1200.19	$1078.62	17
Oregon	290	$2191.49	$1707.89	17
Delaware	289	$1719.08	$1342.94	12
New Jersey	279	$1619.73	$1149.83	19
Washington	273	$1877.52	$1479.92	15
Massachusetts	267	$1579.19	$1243.15	13
Idaho	204	$877.08	$759.60	15
Nebraska	184	$1657.74	$1437.36	14
Iowa	171	$1143.27	$1002.77	10
Utah	168	$2317.26	$1963.70	12
Alaska	157	$1256.73	$824.20	9
Minnesota	152	$853.47	$723.83	12
North Dakota	133	$998.92	$821.01	5
Kentucky	120	$1178.67	$938.47	10
South Dakota	109	$899.15	$753.63	8
Montana	91	$1081.74	$828.89	6
Nevada	63	$1096.28	$858.71	4
New Mexico	48	$1136.49	$874.11	3
Wisconsin	46	$2605.01	$2337.05	3
New Hampshire	41	$1285.77	$999.49	3
Wyoming	36	$1680.99	$1334.52	2
AE	22	$221.37	$90.92	1
Connecticut	14	$1691.24	$1164.34	1
District of Columbia	13	$1581.82	$898.71	1
Puerto Rico	12	$246.34	$107.23	1

Related codes

22558Fusion of lower spine bone through abdomen$707.92
22552Fusion of upper spine bone$268.72
22585Fusion of spine bones through front of body$215.15
22514Treatment of broken lower spine bone$2517.60
22513Treatment of broken middle spine bone$2432.63
22515Treatment of broken spine bone$1212.70

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.