How much does Medicare pay for CPT 22853?

Medicare allowed an average of $172.21 per service and paid $137.48 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1215.94, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 22853?

Insertion of cage or mesh device to spine bone and disc space during spine fusion. It was billed 175,835 times to 107,260 Medicare beneficiaries by 4,129 providers in 2024.

Does 22853 pay differently in an office than a hospital?

Yes. The allowed amount averaged $165.10 in an office setting and $172.22 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 22853 most?

Orthopedic Surgery, with 59,460 services from 1,309 clinicians. Next are Neurosurgery, Physician Assistant, Nurse Practitioner.

CPT 22853

Insertion of cage or mesh device to spine bone and disc space during spine fusion

$172.21Medicare-allowed amount per service, averaged across 175,835 services

Providers submitted

$1215.94

Asking price, not received

Medicare allowed

$172.21

The fee schedule figure

Medicare paid

$137.48

Balance is patient coinsurance

Providers submitted an average of $1215.94 for this code and Medicare allowed $172.21 — 7.1× 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 $137.48 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $165.10
Hospital / facility: $172.22

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 246 services were billed in an office setting and 175,589 in a facility.

Services: 175,835
Beneficiaries: 107,260
Providers billing it: 4,129
Total allowed: $30,280,545

What Medicare pays for CPT 22853

Across 175,835 services billed by 4,129 providers to 107,260 beneficiaries, Medicare allowed an average of $172.21 per service. That is 1.6 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 22853

Specialty	Services	Beneficiaries	Avg allowed	Providers
Orthopedic Surgery	59,460	36,348	$236.19	1,309
Neurosurgery	58,873	35,596	$239.94	1,398
Physician Assistant	44,600	27,314	$33.73	1,083
Nurse Practitioner	9,870	6,061	$33.30	266
General Surgery	1,035	683	$68.29	26
Vascular Surgery	1,014	658	$44.43	22
Neurology	385	224	$211.73	11
Osteopathic Manipulative Medicine	165	95	$239.52	2
Thoracic Surgery	62	39	$44.97	1
Undefined Physician type	62	39	$244.84	1
Certified Clinical Nurse Specialist	58	35	$34.91	1
Interventional Radiology	47	26	$38.61	1
Internal Medicine	40	24	$39.48	1
Cardiology	39	31	$238.31	1
Family Practice	34	22	$40.38	1

22853 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	16,006	$180.59	$132.36	331
Texas	15,863	$174.07	$140.32	350
California	14,541	$183.26	$144.88	323
North Carolina	6,686	$161.27	$138.83	164
Arizona	6,359	$167.94	$139.72	125
Georgia	6,330	$174.22	$141.32	147
Virginia	6,184	$170.11	$140.29	125
Colorado	5,790	$163.24	$131.87	129
Ohio	5,741	$176.06	$143.87	139
Illinois	5,692	$193.65	$140.34	146
Louisiana	5,228	$143.87	$121.46	89
Tennessee	5,013	$170.13	$155.24	114
Maryland	4,544	$194.42	$145.80	80
New York	4,536	$218.85	$156.08	134
South Carolina	4,525	$153.20	$131.08	102
Pennsylvania	4,247	$193.30	$155.43	113
Indiana	4,213	$145.20	$131.98	115
Michigan	3,953	$203.88	$154.41	114
Alabama	3,700	$131.90	$120.54	93
Missouri	3,591	$166.79	$137.14	96
Oklahoma	3,529	$162.00	$139.73	67
Washington	3,223	$159.75	$134.71	82
Massachusetts	2,977	$206.99	$162.28	79
Minnesota	2,756	$153.62	$137.61	71
New Jersey	2,405	$174.67	$132.20	77
Kansas	2,325	$148.18	$132.67	50
Nebraska	2,086	$133.75	$125.05	51
Oregon	2,071	$160.90	$138.99	56
Utah	2,003	$166.08	$138.38	49
Kentucky	1,893	$192.62	$162.65	57
Arkansas	1,801	$163.41	$149.24	44
Nevada	1,731	$150.17	$125.76	45
Idaho	1,667	$143.49	$129.99	46
Mississippi	1,496	$147.22	$129.84	30
Iowa	1,435	$167.56	$150.06	35
Montana	1,232	$176.18	$142.07	27
South Dakota	1,142	$136.09	$122.28	28
Wisconsin	1,043	$165.68	$149.28	36
Connecticut	963	$188.60	$139.62	35
Alaska	943	$186.17	$123.04	18
North Dakota	909	$152.69	$133.80	11
New Mexico	559	$163.97	$129.79	16
Wyoming	543	$174.52	$144.93	14
New Hampshire	521	$161.10	$129.02	19
District of Columbia	470	$234.36	$166.21	13
Delaware	432	$154.60	$128.84	12
West Virginia	332	$171.67	$133.74	8
Rhode Island	223	$205.13	$161.46	10
Puerto Rico	132	$157.03	$131.29	3
Maine	104	$203.35	$174.86	5
Vermont	60	$179.87	$160.88	3
AE	59	$33.57	$27.24	1
Hawaii	28	$191.23	$163.94	2

Related codes

22842Placement of stabilizing device to back$533.80
22840Placement of stabilizing device to back of 1 spine bone in neck$513.09
22845Placement of stabilizing device to front$497.22
22843Placement of stabilizing device to back$660.26
22848Insertion of instrumentation to pelvic bones$275.32
22830Exploration of spine fusion$310.27
22846Placement of stabilizing device to front$530.39
22854Insertion of cage or mesh device in disc space during spine fusion$220.52

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.