CPT 22586 Presacral Interbody Fusion Reimbursement | OpenPayer

Summary & Overview

CPT 22586: Presacral Interbody Spinal Fusion for Lower Lumbar Disc Herniation

CPT code 22586 denotes a presacral interbody spinal fusion procedure performed to treat a herniated nucleus pulposus at the distal lumbar spine near the sacrum. The surgeon excises disc material, may place bone graft in the interbody space via a presacral approach, and secures the construct with posterior spinal instrumentation under image guidance. This code captures a complex reconstructive spinal surgery with implications for clinical outcomes, utilization, and payment policy across the country.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, common billing and service-line considerations, and nationally focused benchmarks where available. The publication outlines payer coverage patterns, typical sites of service, and how the code is used in surgical practice. It also highlights relevant policy developments and coding practice issues that affect billing and prior authorization workflows. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCignaUnitedHealthcareMedicare22586CPTspinal fusionpresacral interbodylumbar spine surgeryorthopedic surgeryneurosurgeryimage guidanceposterior instrumentation

Billing Code Overview

CPT code 22586 describes a surgical spinal fusion procedure performed to correct a herniated nucleus pulposus (a bulging or herniated disc) at the base of the lower back near the tailbone. The operation involves excision of the offending disc material and may include placement of a bone graft using a presacral interbody technique. The procedure is completed with posterior spinal instrumentation and the use of image guidance to assist with placement and alignment.

Service type: Surgical spinal fusion with interbody approach for lower lumbar/presacral disc pathology
Typical site of service: Inpatient or outpatient surgical setting such as an operating room within a hospital or ambulatory surgery center

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient with chronic low back pain and progressive radiculopathy refractory to conservative measures presents for surgical management. Imaging (MRI) demonstrates a symptomatic herniated nucleus pulposus at the lumbosacral junction with segmental instability and severe foraminal stenosis. The spine surgeon performs a presacral interbody fusion with excision of disc material, placement of bone graft in the interbody space, use of intraoperative image guidance, and posterior spinal instrumentation to achieve permanent fusion between two vertebrae.

The clinical workflow includes preoperative evaluation and imaging, anesthesia clearance, intraoperative neuromonitoring as indicated, administration of general anesthesia, positioning and sterile preparation, fluoroscopic or navigation-guided discectomy and interbody graft placement via a presacral approach, posterior instrumentation and rod fixation, hemostasis and closure, postoperative recovery in PACU, and inpatient or outpatient postoperative pain management and physical therapy planning. Documentation should capture indication, levels fused, technique (presacral interbody, image guidance, posterior instrumentation), implants used, estimated blood loss, any intraoperative complications, and discharge instructions.

Coding Specifications

Modifier	Description	When to Use
`00`	Default/No modifier	Use when no other modifier applies and payer requires explicit code for no modifier.

Related Codes

CPT-22558-ANTERIOR-LUMBAR-SPINAL-FUSION

CPT 22558: Anterior Lumbar Spinal Fusion

22551-ARTHRODESIS-ANTERIOR-INTERBODY-INCLUDING-DISC-SPACE

CPT 22551: Anterior Interbody Arthrodesis for Cervical Spine Stabilization

CPT-22554-ANTERIOR-CERVICAL-SPINAL-FUSION

CPT 22554: Anterior Cervical Spinal Fusion

CPT-22548-CERVICAL-SPINE-ARTHRODESIS-ANTERIOR-TRANSORAL

CPT 22548: Cervical Spine Arthrodesis (Anterior/Transoral)

CPT-22556-THORACIC-SPINAL-FUSION-LATERAL-TRANSTHORACIC

CPT 22556: Thoracic Spinal Fusion via Lateral Transthoracic Approach

CPT-22552-ANTERIOR-CERVICAL-ARTHRODESIS-ADDITIONAL-LEVEL

CPT 22552: Anterior Cervical Arthrodesis, Additional Level

CPT-22585-SPINAL-FUSION-ADDITIONAL-VERTEBRAL-SEGMENT

CPT 22585: Spinal Fusion, Additional Vertebral Segment

Taxonomy Code	Specialty	Notes
Data not available in the input.	Neurosurgery	Neurosurgeons commonly perform lumbar interbody fusion and posterior instrumentation.
Data not available in the input.	Orthopaedic Spine Surgery	Orthopaedic spine surgeons perform lumbosacral fusion and instrumentation.
Data not available in the input.	Pain Medicine/Interventional Pain Management	May be involved pre- and postoperatively for pain control and injections.
Data not available in the input.	Anesthesiology	Provides general anesthesia and perioperative pain management.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M51.26`	Other intervertebral disc displacement, lumbosacral region	Represents lumbar disc herniation at the lumbosacral junction commonly treated with discectomy and fusion.
`M51.27`	Other intervertebral disc displacement, lumbosacral region, mid-cervical? (alternate)	Use with caution; typically lumbar disc displacement codes apply to presacral interbody pathology.
`M54.16`	Radiculopathy, lumbosacral region	Describes nerve root compression symptoms prompting surgical decompression and fusion.
`M43.16`	Spondylolisthesis, lumbosacral region	Segmental instability often requiring fusion in addition to discectomy.
`M48.06`	Spinal stenosis, lumbar region	Central or foraminal stenosis contributing to neurologic symptoms and indicating decompression with fusion.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`22586`	Arthrodesis, posterior interbody technique, lumbosacral (presacral interbody approach) with discectomy, includes posterior instrumentation and image guidance as reported in the operative note.	Primary procedure for presacral interbody fusion with posterior instrumentation.
`22551`	Arthrodesis, posterior or posterolateral technique, single level; lumbar	Often reported when additional posterior fusion/arthrodesis at the same level or adjacent levels is performed in conjunction with interbody fusion.
`22612`	Arthrodesis, posterior or posterolateral technique, lumbosacral; 1 level	May be used when posterior fusion techniques are billed separately for the same level as supplemental posterior fusion.
`22842`	Posterior segmental instrumentation (e.g., pedicle fixation), 3 to 6 vertebral segments	Used to report the posterior instrumentation component when instrumentation codes are reported separately per payer policy.
`77002`	Fluoroscopic guidance for spinal procedures	Used to report intraoperative fluoroscopic imaging guidance if billed separately by imaging provider.
`93880`	Intraoperative neurophysiological monitoring (example code)	Used when neuromonitoring is performed and billed separately; specific codes vary by service and payer.