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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.

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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

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

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Billing Code Overview

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.
`11`	Primary/Default	Use when the service is the primary procedure and no additional reporting modifier is required.
`22`	Unusual procedural services	Use when work is substantially greater than typically required for `22586`; documentation must justify increased intensity or time.
`23`	Unusual anesthesia	Use when an intraoperative medical condition requires anesthesia services greater than expected for this procedure.
`26`	Professional component	Use when separating the professional component of a service (for example, professional interpretation of intraoperative imaging billed separately by a radiologist).
`50`	Bilateral procedure	Use when the procedure is performed bilaterally and payer allows bilateral modifier reporting for the specific service.
`62`	Two surgeons	Use when two surgeons from different specialties perform distinct portions of the procedure and both report services.
`63`	Procedure performed on infants less than 4 kg	Use when applicable for very small pediatric patients; include age/weight documentation.
`66`	Surgical team (team surgeon)	Use when a surgical team approach is utilized and payer recognizes team reporting.
`73`	Discontinued outpatient procedure prior to anesthesia administration	Use when procedure was cancelled after patient preparation but before anesthesia in the outpatient setting.
`78`	Unplanned return to OR for related procedure during postoperative period	Use when the patient returns to the operating room for a related procedure during the global period.
`79`	Unrelated procedure or service during global period	Use when an unrelated procedure is performed during the global period (not in modifier list but often relevant); if payer requires, consider appropriate global modifiers.
`80`	Assistant surgeon	Use when an assistant surgeon actively assists and payer requires assistant surgeon reporting.
`81`	Minimum assistant surgeon	Use when only minimal assistance is provided and payer distinguishes by modifier.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist	Use when the service is performed by or shared with an advanced practice clinician per payer policy.

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.

CPT 22548: Cervical Spine Arthrodesis (Anterior/Transoral)

CPT-22551-ANTERIOR-CERVICAL-DISCECTOMY-FUSION

CPT 22551: Anterior Cervical Discectomy with Interbody Fusion

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

CPT 22552: Anterior Cervical Arthrodesis, Additional Level

CPT-22554-ANTERIOR-CERVICAL-SPINAL-FUSION

CPT 22554: Anterior Cervical Spinal Fusion

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

CPT 22556: Thoracic Spinal Fusion via Lateral Transthoracic Approach

CPT-22558-ANTERIOR-LUMBAR-SPINAL-FUSION

CPT 22558: Anterior Lumbar Spinal Fusion

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

CPT 22585: Spinal Fusion, Additional Vertebral Segment

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

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.
`11`	Primary/Default	Use when the service is the primary procedure and no additional reporting modifier is required.
`22`	Unusual procedural services	Use when work is substantially greater than typically required for `22586`; documentation must justify increased intensity or time.
`23`	Unusual anesthesia	Use when an intraoperative medical condition requires anesthesia services greater than expected for this procedure.
`26`	Professional component	Use when separating the professional component of a service (for example, professional interpretation of intraoperative imaging billed separately by a radiologist).
`50`	Bilateral procedure	Use when the procedure is performed bilaterally and payer allows bilateral modifier reporting for the specific service.
`62`	Two surgeons	Use when two surgeons from different specialties perform distinct portions of the procedure and both report services.
`63`	Procedure performed on infants less than 4 kg	Use when applicable for very small pediatric patients; include age/weight documentation.
`66`	Surgical team (team surgeon)	Use when a surgical team approach is utilized and payer recognizes team reporting.
`73`	Discontinued outpatient procedure prior to anesthesia administration	Use when procedure was cancelled after patient preparation but before anesthesia in the outpatient setting.
`78`	Unplanned return to OR for related procedure during postoperative period	Use when the patient returns to the operating room for a related procedure during the global period.
`79`	Unrelated procedure or service during global period	Use when an unrelated procedure is performed during the global period (not in modifier list but often relevant); if payer requires, consider appropriate global modifiers.
`80`	Assistant surgeon	Use when an assistant surgeon actively assists and payer requires assistant surgeon reporting.
`81`	Minimum assistant surgeon	Use when only minimal assistance is provided and payer distinguishes by modifier.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist	Use when the service is performed by or shared with an advanced practice clinician per payer policy.

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.

CPT 22548: Cervical Spine Arthrodesis (Anterior/Transoral)

CPT-22551-ANTERIOR-CERVICAL-DISCECTOMY-FUSION

CPT 22551: Anterior Cervical Discectomy with Interbody Fusion

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

CPT 22552: Anterior Cervical Arthrodesis, Additional Level

CPT-22554-ANTERIOR-CERVICAL-SPINAL-FUSION

CPT 22554: Anterior Cervical Spinal Fusion

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

CPT 22556: Thoracic Spinal Fusion via Lateral Transthoracic Approach

CPT-22558-ANTERIOR-LUMBAR-SPINAL-FUSION

CPT 22558: Anterior Lumbar Spinal Fusion

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

CPT 22585: Spinal Fusion, Additional Vertebral Segment

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

OpenPayer

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

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Billing Code Overview

OpenPayer

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

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References