ACDF surgery (CPT 22551): what Medicare pays the surgeon, the hospital and the surgery center

What does Medicare pay for a one-level ACDF?

For a one-level anterior cervical discectomy and fusion (CPT 22551), the Medicare national unadjusted amount is $1,604.91 for the surgeon (Physician Fee Schedule, October 2026 release, facility setting), $13,116.76 for the hospital outpatient department (OPPS, July 2026 release) and $9,030.96 for an ambulatory surgery center (ASC, July 2026 release). Anesthesia is billed separately. These are benchmarks before geographic adjustment.

The bill, line by line

The table lists the codes that commonly appear with a one-level ACDF and what each schedule does with them. The surgeon's claim pays 22552, 22845 and 22853 as separate lines. The hospital's and the surgery center's claims pay one amount for 22551 and nothing separate for the others.

CMS marks the office setting not applicable for 22551, 22552, 22845 and 22853, so the surgeon column is the facility setting only. The CMS relative value file gives 22551 a global period of 090 days and multiple-procedure indicator 2. The add-on codes 22552, 22845 and 22853 carry global ZZZ and multiple-procedure indicator 0, so the multiple-procedure rule does not reduce them. Of the ASC amount for 22551, $4,811.54 is the device portion.

Why are the hospital and surgery center amounts so much larger than the surgeon's?

The surgeon, the hospital and the surgery center are paid under different Medicare schedules, each on its own claim. The Physician Fee Schedule prices the surgeon's claim code by code. OPPS and the ASC schedule price the facility's claim with one rate for the primary procedure and package the add-on codes into it.

CMS defines the indicators in the table in these words.

• J1 (OPPS, 22551): “Paid under OPPS; all covered Part B services on the claim are packaged with the primary "J1" service for the claim, except the Comprehensive APC payment policy exclusions found in the most recent Addendum J.”
• N (OPPS, add-on codes): “Paid under OPPS; payment is packaged into payment for other services. Therefore, there is no separate APC payment.”
• J8 (ASC, 22551): “Device-intensive procedure; paid at adjusted rate.”
• N1 (ASC, add-on codes): “Packaged service/item; no separate payment made.”

For a reviewer, the point is this. On the surgeon's claim, 22552, 22845 and 22853 are each a separate payable line. On the hospital's or the surgery center's claim, they are packaged into the one rate for 22551. A facility bill that prices them separately is asking for something Medicare packages. For how OPPS amounts compare with what hospitals post, see hospital prices vs Medicare.

Which schedule prices the hospital, outpatient or inpatient?

The schedule depends on whether the patient was admitted. If the patient is not admitted, the hospital outpatient amount in Table 1 applies. If the patient is admitted, the hospital is paid a per-stay MS-DRG amount instead of the outpatient rate, and the OPPS figure above does not apply.

This article gives no inpatient figure. To price an admitted stay, use the hospital inpatient payment rate lookup.

How is anesthesia for an ACDF priced?

The anesthesia provider bills separately from the surgeon's code. Medicare prices that bill from base units plus time units, multiplied by a conversion factor for the locality. The 2026 national anesthesia conversion factor is $20.49754 (non-qualifying APM; CY2026 PFS final rule, CMS-1832-F, 90 FR 49266).

The Medicare Claims Processing Manual, chapter 12 section 50.A, states that the fee schedule amount “is, with the exceptions noted, based on allowable base and time units multiplied by an anesthesia conversion factor specific to that locality.” Section 50.G states the time unit rule: “Actual anesthesia time in minutes is reported on the claim. For anesthesia services furnished, the A/B MAC computes time units by dividing reported anesthesia time by 15 minutes. Round the time unit to one decimal place.”

CMS publishes the base units for each anesthesia code, and section 50.A says “the base unit for each anesthesia procedure is communicated to the A/B MACs by means of the HCPCS file released annually.” This article states no base unit. The anesthesia conversion factor lookup gives the locality factor and the formula.

What does the 90-day global period mean for the surgeon's charges?

The CMS relative value file lists 22551 with a global period of 090 days. Routine follow-up visits by the surgeon during those 90 days are included in the $1,604.91, so Medicare does not pay them as separate charges.

How do local amounts differ from these national ones?

Every figure on this page is a national unadjusted amount, before geographic adjustment. Medicare payment in a given locality is adjusted for that locality, so a claim there differs from these figures.

• Surgeon: the 22551 rate page.
• Hospital outpatient: the hospital outpatient payment rate lookup.
• Surgery center: the ASC fee schedule lookup.

What can this article not tell you?

The figures on this page are Medicare national unadjusted reference amounts for one code and its add-on codes. Each locality adjusts them, and they say nothing about what a provider billed.

• Medicare is a benchmark. It is not what an auto, no-fault or workers' compensation carrier owes.
• Release dates. The OPPS and ASC figures are the July 2026 releases, the latest in our archive. The surgeon figures are the October 2026 release.
• Not a coding or necessity opinion. This article does not decide medical necessity or whether the codes billed were the right ones.
• Not legal advice. It is a description of how Medicare prices these codes.