CPT 22612: Lumbar spinal fusion, posterior
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 22612?
Posterior lumbar spinal fusion — a major surgery that permanently connects two or more vertebrae in the lower back using bone grafts, screws, and rods. Used for severe disc disease, spinal instability, or spondylolisthesis.
Typical setting: Hospital inpatient.
What CPT 22612 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $1876 for CPT 22612 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($2251–$3377). Hospital chargemaster prices for CPT 22612 often range from $4000 to $25000 — a markup of 2.1x to 13.3x over Medicare.
Common overcharges on CPT 22612
Spinal fusion is among the highest-cost surgeries in the U.S. Watch for: post-operative office visits billed during the 90-day global period, implant/hardware charges marked up 5-10× above cost, and billing both the fusion and a separate decompression (63030) when the decompression was part of the fusion approach.
63030. Per CMS NCCI edits, these services are bundled.About Orthopedics billing
Orthopedic procedures — joint surgeries, fracture repairs, spine operations, and arthroscopy — are among the highest-billed categories in medicine. Facility fees, implant markups, and bundled post-operative care create frequent billing disputes.
Request the operative report — it documents exactly what was performed. For arthroscopy, verify that diagnostic and therapeutic codes are not both billed. For fracture care, confirm only one treatment method (closed or open) is charged. Check that follow-up visits within the global period are not separately billed.
How to dispute a CPT 22612 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($2814), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 22612 on your bill?
Upload your bill. We scan every line for overcharges, upcoding, and improper unbundling — then generate a dispute letter backed by federal law. Free for uninsured and veterans.