How much does Medicare pay for CPT 22630?

Medicare allowed an average of $1109.53 per service and paid $883.16 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $6480.34, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 22630?

Fusion of lower spine bone and partial removal of spine bone or disc through back, 1 disc. It was billed 2,345 times to 2,330 Medicare beneficiaries by 117 providers in 2024.

Does 22630 pay differently in an office than a hospital?

Yes. The allowed amount averaged $1337.32 in an office setting and $1108.06 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 22630 most?

Neurosurgery, with 1,310 services from 65 clinicians. Next are Physician Assistant, Orthopedic Surgery, Nurse Practitioner.

CPT 22630

Fusion of lower spine bone and partial removal of spine bone or disc through back, 1 disc

$1109.53Medicare-allowed amount per service, averaged across 2,345 services

Providers submitted

$6480.34

Asking price, not received

Medicare allowed

$1109.53

The fee schedule figure

Medicare paid

$883.16

Balance is patient coinsurance

Providers submitted an average of $6480.34 for this code and Medicare allowed $1109.53 — 5.8× 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 $883.16 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $1337.32
Hospital / facility: $1108.06

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. 15 services were billed in an office setting and 2,330 in a facility.

Services: 2,345
Beneficiaries: 2,330
Providers billing it: 117
Total allowed: $2,601,848

What Medicare pays for CPT 22630

Across 2,345 services billed by 117 providers to 2,330 beneficiaries, Medicare allowed an average of $1109.53 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 22630

Specialty	Services	Beneficiaries	Avg allowed	Providers
Neurosurgery	1,310	1,304	$1472.68	65
Physician Assistant	608	603	$202.94	30
Orthopedic Surgery	370	366	$1386.19	18
Nurse Practitioner	39	39	$201.21	3
Neurology	18	18	$1584.17	1

22630 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	407	$1133.65	$788.97	16
California	274	$1099.79	$829.33	11
Nebraska	134	$783.19	$688.96	4
South Carolina	129	$1001.64	$831.16	6
Kentucky	122	$1165.24	$983.55	7
Indiana	119	$1031.18	$914.18	7
Louisiana	115	$563.33	$463.14	4
New Mexico	108	$812.13	$583.19	7
Illinois	99	$1326.45	$881.47	5
Massachusetts	92	$1528.18	$1218.61	4
Georgia	85	$1060.39	$821.26	6
Montana	80	$1529.96	$1236.72	2
Tennessee	67	$1337.24	$1216.70	5
Michigan	58	$1560.37	$1238.60	4
Utah	57	$966.28	$768.69	4
Alabama	56	$836.01	$726.48	2
Colorado	54	$874.05	$656.90	3
Ohio	48	$1203.05	$1001.02	3
Arizona	41	$929.10	$729.13	2
Missouri	39	$1466.19	$1228.26	3
Virginia	36	$901.59	$718.06	2
Pennsylvania	23	$1505.04	$1230.61	2
New Jersey	21	$1665.33	$1234.83	1
Nevada	13	$1535.33	$1197.80	1
Arkansas	12	$1344.23	$1220.52	1
New Hampshire	12	$1543.09	$1235.08	1
Alaska	11	$1598.83	$1066.27	1
Kansas	11	$1312.46	$1175.03	1
Mississippi	11	$1335.08	$1234.92	1
Washington	11	$1597.68	$1118.36	1

Related codes

22614Fusion of additional segment of spine$284.08
22612Fusion of spine in lower back$1477.10
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
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.