Lumbar fusion codes 22630 and 22633 land on the ASC list for 2026 — five years after CMS first opened, then shut, the door
The CY2026 final rule adds posterior lumbar interbody fusion (22630) and combined PLIF (22633) to the ASC covered-procedures list — instrumented spine work CMS first cleared toward outpatient settings in 2021 and walked back in 2022.
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CMS added two instrumented lumbar fusion codes — 22630 and 22633 — to the ASC covered-procedures list in the CY2026 OPPS/ASC final rule. They sit inside the 276 procedures the rule adds to the ASC CPL on revised clinical criteria, separate from the 271 codes coming off the inpatient-only list. The agency’s own rule analysis from ASCA names them plainly: “Spine Codes — Posterior Lumbar Interbody Fusion: 22630 / Combined Posterior Lumbar and Posterior Lumbar Interbody Fusion: 22633.”
This is the second time CMS has opened the door. The final rule’s own history section records that the agency removed lumbar spine fusion from the inpatient-only list “in CY 2021 (82 FR 59383; 84 FR 61354; 85 FR 86093)” — the regulatory step that first put these procedures on a path toward outpatient and ASC settings. It did not last. “In the 2022 OPPS/ASC final rule with comment period, published on November 16, 2021, we halted the elimination of the IPO list and… we returned most services removed from the IPO list in 2021 back to the IPO list,” the rule states. Fusion went back inpatient-only. The CY2026 rule is the reversal of that reversal.
What changes for an operator
The economics differ from anything most ASCs run today. Instrumented fusion is device-intensive: 22630 and 22633 are reported with interbody-cage implant code C1831, and the final rule discusses them in the context of device pass-through payment, confirming both “are procedures that can be performed in the outpatient setting.” That carries materially higher case revenue and implant cost than the laminectomy and discectomy decompressions a spine-capable ASC already performs — the implant alone can rival the facility fee, so the device-offset and pass-through math drives the margin, not the procedure rate.
The harder constraint is the building, not the code. Under 42 CFR 416.2, an ASC operates “exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission.” Fusion patients who need a longer recovery cannot be kept; underwriting a fusion line means modeling patient selection against that 24-hour ceiling before modeling the rate.
For now, the codes are eligible, not yet booked. Centers weighing a fusion line should price the implant pass-through and the device-offset percentage against their own case mix — and confirm a discharge pathway that clears the same-day window — before treating 22630 and 22633 as revenue.