CPT 22865 Lumbar Artificial Disk Removal Reimbursement | OpenPayer

Summary & Overview

CPT 22865: Lumbar Artificial Disk Removal

CPT code 22865 denotes the surgical removal (explantation) of a single lumbar artificial disk previously placed during total disk arthroplasty. This code captures a distinct, device-focused revision procedure that can be clinically complex and may require hospital-based operative care. Nationally, procedures addressing failed or symptomatic lumbar disk arthroplasty affect care pathways, resource utilization, and device-surveillance activity, making accurate coding and clinical documentation important for outcomes tracking and payment alignment. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent of the code, typical sites of service, common modifiers and billing considerations, and how this procedure fits into spine surgery service lines. The publication also outlines benchmarking elements and policy context relevant to reimbursement and utilization for national stakeholders. Data not available in the input for specific payer edits, associated taxonomies, and ICD-10 pairing are noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare22865CPTlumbar diskdisk arthroplastyspine surgeryexplantationorthopedicsneurosurgery

Billing Code Overview

CPT code 22865 describes the removal of a single artificial disk from the lumbar spine that was previously implanted as part of a total disk arthroplasty. This procedure is performed to address persistent or recurrent symptoms from degenerative disk disease or other symptomatic lumbar disk conditions following prior disk replacement.

Service type: Surgical explantation of a lumbar artificial disk
Typical site of service: Hospital inpatient or outpatient surgical setting, depending on clinical indications and perioperative requirements

Clinical & Coding Specifications

Clinical Context

A typical patient is a 45–65-year-old adult with a prior lumbar total disc arthroplasty who presents with recurrent back pain, radiculopathy, device failure, infection, heterotopic ossification, subsidence, or adjacent segment disease. Conservative measures (physical therapy, medications, epidural steroid injections) have failed and imaging (X-ray, CT, MRI) shows loosening, malposition, migration, or mechanical failure of the artificial lumbar disc. The surgical workflow includes preoperative assessment with history and physical, targeted imaging, optimization of comorbidities, informed consent discussing risks of explantation and possible fusion, anesthesia evaluation, and perioperative antibiotics. In the operating room the patient is positioned for an anterior or posterior approach as indicated; the prior prosthetic disk is exposed, implanted components are identified, explanted carefully with attention to endplate integrity and neural elements, and the surgeon may perform debridement, repair of bone defects, and conversion to an instrumented fusion if required. Postoperative care includes pain control, wound monitoring, mobilization with physical therapy, and follow-up imaging to document construct stability and healing.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services	Use when work, time, or complexity substantially exceeds typical for `22865` (document increased work/complexity).

CPT 22858: Cervical Total Disc Arthroplasty, Second Level

CPT-22841-SPINAL-WIRING-VERTEBRAL-FIXATION

CPT 22841: Spinal Wiring for Vertebral Fixation

CPT-22842-POSTERIOR-SPINAL-INSTRUMENTATION-3-TO-6-LEVELS

CPT 22842: Posterior Spinal Instrumentation, 3–6 Levels

CPT-22847-ANTERIOR-SPINAL-INSTRUMENTATION-8-PLUS-SEGMENTS

CPT 22847: Anterior Spinal Instrumentation, 8+ Vertebral Segments

CPT-22849-SPINAL-FIXATION-DEVICE-REINSERTION

CPT 22849: Reinsertion of Spinal Fixation Device

CPT-22862-LUMBAR-TOTAL-DISK-ARTHROPLASTY-REVISION

CPT 22862: Revision of Lumbar Total Disk Arthroplasty

CPT-22838-THORACIC-VERTEBRAL-BODY-TETHER-REVISION-REPLACEMENT-REMOVAL

CPT 22838: Thoracic Vertebral Body Tether Revision/Replacement/Removal

CPT-22856-CERVICAL-ARTIFICIAL-DISC-REPLACEMENT-SINGLE-LEVEL

CPT 22856: Cervical Artificial Disc Replacement, Single Level

CPT-22840-C1-C2-SPINAL-INSTRUMENTATION-DEFORMITY-CORRECTION

CPT 22840: C1–C2 Spinal Instrumentation for Deformity Correction

CPT-22870-INTERSPINOUS-DEVICE-ADDITIONAL-LUMBAR-LEVEL-MINIMALLY-INVASIVE

CPT 22870: Interspinous/Interlaminar Stabilization Device, Additional Lumbar Level

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Taxonomy Code	Specialty	Notes
`208100000X`	Orthopedic Surgery	Spine surgeons who manage degenerated disc implants and explantation.
`2086S0200X`	Neurosurgery	Neurosurgeons performing complex spinal implant removal and possible fusion.
`207R00000X`	Physical Medicine & Rehabilitation	Physiatrists involved in pre/postoperative optimization and nonoperative management.
`208000000X`	General Surgery	General surgeons with vascular/anterior approach expertise may assist in exposure.
`363LP0800X`	Pain Medicine	Interventional pain specialists provide diagnostic/therapeutic injections and nonsurgical care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M51.36`	Other intervertebral disc degeneration, lumbar region, with myelopathy	Degenerative disc disease affecting lumbar level that often leads to disc arthroplasty and may necessitate explantation if symptomatic or failed.
`M51.37`	Other intervertebral disc degeneration, lumbar region, with radiculopathy	Lumbar disc degeneration causing nerve root compression and radicular pain that may persist after arthroplasty requiring removal.
`M96.641`	Postprocedural mechanical complication of internal orthopedic device, implant and graft, lumbar region	Directly applicable for mechanical failure, loosening, migration, or breakage of the artificial disc prompting `22865`.
`T84.89XA`	Other complications of internal prosthetic devices, implants and grafts, initial encounter	General code used for complications related to the implanted disc such as infection, pain, or dysfunction during initial encounter.
`T81.4XXA`	Infection following a procedure, initial encounter	Used when postoperative or device-related infection is the indication for explantation.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`22830`	Exploration of spinal fusion with removal of instrumentation	Used when removal of prior spinal instrumentation or hardware is required during or before conversion after explantation of artificial disc.
`22845`	Anterior instrumentation for spinal fusion, removal	Relevant if anterior instrumentation must be removed during an anterior approach for disc explantation and/or conversion to fusion.
`22612`	Arthrodesis, posterior or posterolateral technique, single level lumbar	Commonly performed if the surgeon converts the explantation to an instrumented lumbar fusion at the same level.
`22633`	Arthrodesis, combined posterior or posterolateral and interbody technique, single level lumbar	Used when explantation is followed by combined posterior fusion plus interbody fusion during the same operative session.
`22851`	Application of interbody biomechanical device (e.g., cage) with lumbar fusion	Used when an interbody device is placed after removal of the prosthetic disc as part of fusion reconstruction.
`72131`	Radiologic examination, lumbar spine, CT or MRI (example code for intraoperative/diagnostic imaging)	Used preoperatively or postoperatively for assessment of prosthesis position, loosening, or fusion status (select appropriate imaging CPT code per service).

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