Home / Medicare fees / 22868

22868 Insj stablj dev w/dcmprn

What 22868 is

CMS fee schedule short descriptor: Insj stablj dev w/dcmprn.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 22868 (CY2026)

Work RVUPractice expense RVUMalpractice RVUTotalMedicare rate
Non-facility (office)3.901.311.226.43$214.77
Facility (hospital, ASC)3.901.311.226.43$214.77

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.


Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.

Advertisement

Medically Unlikely Edit (MUE)

Medicare caps 22868 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 22868? These codes are bundled into it

22868 is a Column 1 code in 288 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 codeShort descriptionModifier indicator
0202TPost vert arthrplst 1 lumbar1 - modifier may bypassCheck pair
0213TNjx paravert w/us cer/thor0 - no modifier bypassCheck pair
0216TNjx paravert w/us lumb/sac0 - no modifier bypassCheck pair
0221TPlmt post facet implt lumb1 - modifier may bypassCheck pair
0333TVisual ep scr acuity auto0 - no modifier bypassCheck pair
0464TVisual ep test for glaucoma0 - no modifier bypassCheck pair
0596TTemp fml iu vlv-pmp 1st insj1 - modifier may bypassCheck pair
0597TTemp fml iu valve-pmp rplcmt1 - modifier may bypassCheck pair
0708TId ca immntx prep & 1st njx1 - modifier may bypassCheck pair
0709TId ca immntx each addl njx1 - modifier may bypassCheck pair
0719TPst vrt jt rplcmt lmbr 1 sgm1 - modifier may bypassCheck pair
11000Dbrdmt ecz/infected skin<10%1 - modifier may bypassCheck pair
11001Dbrdmt ecz/infct skn ea addl1 - modifier may bypassCheck pair
11004Dbrdmt skin xtrnl gent&per1 - modifier may bypassCheck pair
11005Dbrdmt skin abdominal wall1 - modifier may bypassCheck pair
11006Dbrdmt skin xtrnl gent per1 - modifier may bypassCheck pair
11042Dbrdmt subq tis 1st 20sqcm/<1 - modifier may bypassCheck pair
11043Dbrdmt musc&/fsca 1st 20/<1 - modifier may bypassCheck pair
11044Dbrdmt bone 1st 20 sq cm/<1 - modifier may bypassCheck pair
11045Dbrdmt subq tiss each addl1 - modifier may bypassCheck pair
11046Dbrdmt musc&/fsca ea addl1 - modifier may bypassCheck pair
11047Dbrdmt bone each addl1 - modifier may bypassCheck pair
12001Rpr s/n/ax/gen/trnk 2.5cm/<1 - modifier may bypassCheck pair
12002Rpr s/n/ax/gen/trnk2.6-7.5cm1 - modifier may bypassCheck pair
12004Rpr s/n/ax/gen/trk7.6-12.5cm1 - modifier may bypassCheck pair
12005Rpr s/n/a/gen/trk12.6-20.0cm1 - modifier may bypassCheck pair
12006Rpr s/n/a/gen/trk20.1-30.0cm1 - modifier may bypassCheck pair
12007Rpr s/n/ax/gen/trnk >30.0 cm1 - modifier may bypassCheck pair
12011Rpr f/e/e/n/l/m 2.5 cm/<1 - modifier may bypassCheck pair
12013Rpr f/e/e/n/l/m 2.6-5.0 cm1 - modifier may bypassCheck pair

Showing 30 of 288 column 2 codes. Use the pair checker for any specific combination.

22868 is bundled into these codes

22868 appears as a Column 2 code in 43 active edits. Reported with one of these Column 1 codes on the same date of service, 22868 is the code that denies.

Column 1 codeShort descriptionModifier indicator
22214Incis 1 vertebral seg lumbar1Check pair
22532Arthrd lat xtrcvtry tq thrc1Check pair
22533Arthrd lat xtrcvtry tq lmbr1Check pair
22534Arthrd lat xtrcvtry tq ea ad1Check pair
22558Arthrd ant ntrbd min dsc lum1Check pair
22612Arthrd pst tq 1ntrspc lumbar1Check pair
22614Arthrd pst tq 1ntrspc ea add1Check pair
22630Arthrd pst tq 1ntrspc lum1Check pair
22632Arthrd pst tq 1ntrspc lm ea1Check pair
22633Arthrd cmbn 1ntrspc lumbar1Check pair
22634Arthrd cmbn 1ntrspc ea addl1Check pair
22800Arthrd pst dfrm<6 vrt sgm1Check pair
22802Arthrd pst dfrm 7-12 vrt sgm1Check pair
22804Arthrd pst dfrm 13+ vrt sgm1Check pair
22818Kyphectomy 1-2 segments1Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.