How much does Medicare pay for CPT 22612?

Medicare allowed an average of $1477.10 per service and paid $1176.65 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $7584.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 22612?

Fusion of spine in lower back. It was billed 44,316 times to 43,601 Medicare beneficiaries by 1,981 providers in 2024.

Does 22612 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1595.70 in an office setting and $1477.00 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 22612 most?

Orthopedic Surgery, with 19,219 services from 838 clinicians. Next are Physician Assistant, Neurosurgery, Nurse Practitioner.

CPT 22612

Fusion of spine in lower back

$1477.10Medicare-allowed amount per service, averaged across 44,316 services

Providers submitted

$7584.11

Asking price, not received

Medicare allowed

$1477.10

The fee schedule figure

Medicare paid

$1176.65

Balance is patient coinsurance

Providers submitted an average of $7584.11 for this code and Medicare allowed $1477.10 — 5.1× 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 $1176.65 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1595.70
Hospital / facility: $1477.00

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 40 services were billed in an office setting and 44,276 in a facility.

Services: 44,316
Beneficiaries: 43,601
Providers billing it: 1,981
Total allowed: $65,459,164

What Medicare pays for CPT 22612

Across 44,316 services billed by 1,981 providers to 43,601 beneficiaries, Medicare allowed an average of $1477.10 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 22612

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	19,219	18,903	$1388.92	838
Physician Assistant	10,737	10,619	$204.76	505
Neurosurgery	9,520	9,384	$1426.30	438
Nurse Practitioner	2,116	2,089	$199.32	95
Ambulatory Surgical Center	1,589	1,519	$13,224	56
Pain Management	291	281	$1491.88	14
Interventional Pain Management	275	254	$1620.72	9
Physical Medicine and Rehabilitation	151	141	$1554.92	6
Anesthesiology	127	125	$1625.09	7
Neurology	47	47	$1154.53	3
Vascular Surgery	36	36	$255.40	1
General Surgery	35	35	$254.73	2
Colorectal Surgery (Proctology)	35	35	$257.77	1
Podiatry	34	31	$258.96	1
Cardiology	32	32	$1456.91	1

22612 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	4,851	$1678.42	$1196.46	204
Texas	4,590	$1727.38	$1383.20	205
Florida	3,472	$2178.07	$1714.42	142
Ohio	1,897	$1023.38	$805.73	83
Maryland	1,648	$1702.71	$1274.74	72
Pennsylvania	1,625	$1846.00	$1444.12	71
North Carolina	1,392	$985.91	$806.09	65
Tennessee	1,389	$1052.92	$905.99	52
Georgia	1,351	$1191.01	$940.40	67
Virginia	1,240	$1018.75	$762.64	53
Oklahoma	1,146	$1089.72	$894.44	54
New York	1,117	$1212.92	$815.76	67
Arizona	1,063	$1451.18	$1174.96	56
Kansas	1,012	$1328.58	$1129.25	37
South Carolina	965	$1269.68	$1053.69	48
New Jersey	961	$2921.84	$2171.14	45
Alabama	938	$1306.15	$1166.85	40
Indiana	925	$889.33	$774.97	41
Iowa	912	$868.78	$739.00	35
Delaware	871	$1680.51	$1306.15	23
Illinois	862	$1074.92	$753.58	39
Louisiana	855	$857.26	$694.37	30
Massachusetts	838	$1360.34	$1006.36	43
Colorado	793	$1331.83	$1041.24	35
Michigan	775	$1864.83	$1455.33	35
Utah	688	$953.52	$757.88	27
Washington	685	$1405.19	$1049.91	33
Missouri	682	$1041.26	$821.53	32
Idaho	551	$1322.84	$1126.56	29
Minnesota	544	$1626.44	$1333.64	24
Nevada	473	$1636.54	$1270.23	24
Kentucky	404	$1090.01	$884.89	21
Nebraska	335	$1940.54	$1626.08	16
Connecticut	321	$1173.31	$823.30	22
Oregon	314	$1591.22	$1255.15	19
Mississippi	269	$1997.29	$1811.42	9
Wisconsin	240	$2151.86	$1845.01	13
South Dakota	209	$828.05	$686.81	13
Rhode Island	164	$1031.78	$794.43	9
District of Columbia	155	$1402.03	$950.79	6
West Virginia	133	$1463.34	$1102.84	6
Montana	115	$1378.02	$1101.45	6
Arkansas	101	$1149.26	$992.58	7
Hawaii	88	$1132.29	$912.62	5
Wyoming	85	$933.31	$738.64	3
New Hampshire	67	$1253.28	$1009.05	3
New Mexico	50	$1128.28	$886.02	3
North Dakota	45	$1038.21	$829.86	3
Puerto Rico	45	$940.01	$757.81	2
Vermont	36	$1208.19	$1038.22	2
Maine	17	$194.33	$90.55	1
Alaska	12	$1877.10	$1240.41	1

Related codes

22614Fusion of additional segment of spine$284.08
22633Fusion of spine in lower back$1195.61
22634Fusion of additional segment of spine$335.52
22600Fusion of spine in neck by posterior approach$850.43
22630Fusion of lower spine bone and partial removal of spine bone or disc t$1109.53
22610Fusion of spine in upper back$673.40

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.