How much does Medicare pay for CPT 22558?

Medicare allowed an average of $707.92 per service and paid $564.26 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $6347.43, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 22558?

Fusion of lower spine bone through abdomen with partial removal of disc. It was billed 24,729 times to 24,380 Medicare beneficiaries by 1,073 providers in 2024.

Which specialty bills 22558 most?

Orthopedic Surgery, with 9,715 services from 450 clinicians. Next are Neurosurgery, Physician Assistant, General Surgery.

CPT 22558

Fusion of lower spine bone through abdomen with partial removal of disc

$707.92Medicare-allowed amount per service, averaged across 24,729 services

Providers submitted

$6347.43

Asking price, not received

Medicare allowed

$707.92

The fee schedule figure

Medicare paid

$564.26

Balance is patient coinsurance

Providers submitted an average of $6347.43 for this code and Medicare allowed $707.92 — 9.0× 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 $564.26 (80%); the rest is the patient’s coinsurance and deductible.

Services: 24,729
Beneficiaries: 24,380
Providers billing it: 1,073
Total allowed: $17,506,154

What Medicare pays for CPT 22558

Across 24,729 services billed by 1,073 providers to 24,380 beneficiaries, Medicare allowed an average of $707.92 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 22558

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	9,715	9,552	$802.15	450
Neurosurgery	4,018	3,908	$843.36	187
Physician Assistant	3,979	3,931	$128.66	197
General Surgery	3,178	3,166	$846.23	96
Vascular Surgery	2,795	2,786	$943.05	99
Nurse Practitioner	593	590	$118.55	30
Thoracic Surgery	186	186	$937.45	5
Cardiac Surgery	131	131	$954.29	5
Critical Care (Intensivists)	50	50	$937.57	2
Interventional Radiology	44	44	$929.65	1
Osteopathic Manipulative Medicine	40	36	$752.31	1

22558 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	3,240	$749.74	$496.33	126
Texas	2,764	$662.77	$474.41	115
Florida	1,891	$791.13	$518.02	84
North Carolina	1,229	$700.87	$532.76	51
Virginia	990	$789.95	$546.07	37
Ohio	950	$750.10	$516.86	37
Louisiana	851	$578.40	$433.04	27
Arizona	841	$711.60	$524.15	35
Georgia	827	$785.50	$561.20	39
Alabama	762	$593.06	$491.38	34
South Carolina	689	$622.23	$501.07	32
Colorado	655	$745.32	$503.95	25
Missouri	612	$632.44	$456.76	28
Tennessee	601	$744.00	$604.35	28
New York	596	$886.36	$569.99	31
Washington	589	$743.31	$517.82	29
Pennsylvania	570	$780.25	$546.23	29
Illinois	499	$666.74	$450.98	23
Oklahoma	434	$623.83	$429.75	18
Maryland	390	$622.15	$445.21	15
Kansas	385	$588.34	$446.67	15
Kentucky	379	$767.42	$515.81	16
Utah	371	$511.40	$387.94	15
Idaho	360	$516.26	$410.10	14
Indiana	353	$639.49	$541.67	18
Minnesota	348	$598.05	$470.61	16
Nevada	343	$583.44	$414.07	17
Oregon	295	$702.60	$564.01	17
New Jersey	223	$834.34	$569.79	14
Michigan	171	$926.24	$643.50	12
Montana	156	$822.27	$557.61	9
South Dakota	155	$740.79	$540.48	6
Iowa	129	$732.49	$627.15	6
District of Columbia	112	$924.58	$540.68	5
New Mexico	103	$600.85	$426.63	3
Connecticut	99	$824.45	$526.29	7
Delaware	96	$450.21	$368.03	4
Wisconsin	95	$786.72	$569.42	5
Nebraska	93	$786.61	$592.71	6
Massachusetts	93	$702.97	$536.23	5
West Virginia	76	$971.11	$779.59	3
Wyoming	66	$460.32	$380.19	2
Mississippi	64	$517.23	$419.01	4
Alaska	47	$898.86	$538.23	3
North Dakota	40	$689.49	$485.16	3
Arkansas	39	$425.77	$346.26	2
Puerto Rico	25	$705.57	$583.70	1
Vermont	19	$969.77	$575.88	1
Rhode Island	14	$946.29	$589.28	1

Related codes

22551Fusion of upper spine bone$1377.46
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.