This page is for the owner, administrator or marketing lead of a spine or orthopedic practice. It shows what Medicare pays the surgeon in 2026 for an anterior cervical discectomy and fusion at a single level, which is a fusion of one disc space in the neck performed through the front, and why that payment moves far more by location than the fee for a joint replacement does.
Every figure is computed from the CMS 2026 physician fee schedule relative value file (October release) and the 2026 geographic index table in the same download, using the facility formula CMS prints in the file’s readme.
I run a marketing agency for surgical practices, including spine groups. A spine case is one of the highest-value cases a practice markets for, so I want its Medicare fee in hand before planning what to spend to win one.
When I reviewed the pages that rank for this procedure’s 2026 Medicare reimbursement, they were a pricing data site, a device maker’s billing and coding guide, payer medical policies, Medicare contractor prior authorization pages and an older study of inflation-adjusted spine reimbursement. One result put the national payment at roughly $1,500. The October 2026 CMS file computes to $1,604.91. None of the results I read showed the payment by locality.
The national payment for 2026
The procedure carries 48.05 total RVUs in the facility setting. At the 2026 conversion factor of $33.4009, the national surgeon payment is $1,604.91.
| Component | RVUs | Dollars | Share |
|---|---|---|---|
| Physician work | 24.38 | $814.31 | 50.7% |
| Practice expense (facility) | 15.43 | $515.38 | 32.1% |
| Malpractice | 8.24 | $275.22 | 17.1% |
| Total | 48.05 | $1,604.91 | 100% |
Clinicians who qualify through an advanced alternative payment model are paid from a version of the file with a conversion factor of $33.5675. That puts this procedure at $1,612.92, a difference of $8.01.
The file lists the procedure as facility only.
Malpractice is a much bigger part of this fee
For a total knee replacement, malpractice makes up 11.6% of the RVUs. For this cervical fusion it is 17.1%, and the malpractice RVUs alone are worth $275.22 at the national rate, about twice the $134.27 malpractice portion of a total knee.
Overall, the cervical fusion pays $445.56 more than a total knee nationally ($1,604.91 against $1,159.35), or about 38.4% more.
That malpractice share matters for the next section, because CMS adjusts malpractice by its own geographic index. Outside Alaska, the 2026 malpractice index runs from 0.296 to 2.529 across localities, while the work index runs only from 1.0 to 1.11.
The payment by locality
CMS applies separate geographic indices to work, practice expense and malpractice for each of 109 payment localities. The 2026 work index has a floor of 1.0, extended by Congress through January 1, 2027.
| Medicare locality | 2026 single-level ACDF surgeon payment |
|---|---|
| Wisconsin (lowest) | $1,392.81 |
| Arkansas | $1,398.76 |
| Alabama | $1,421.04 |
| Rest of Texas | $1,551.93 |
| National | $1,604.91 |
| Los Angeles and Orange County | $1,640.14 |
| Houston | $1,711.30 |
| Suburban Chicago | $1,837.00 |
| Manhattan | $1,901.80 |
| Chicago | $1,969.60 |
| NYC suburbs and Long Island | $1,990.30 |
| Miami (highest) | $2,046.86 |
| Alaska (work index floor of 1.5) | $1,921.99 |
Between Wisconsin and Miami, the same case differs by $654.05, or 47.0%. For a total knee, the gap between the lowest and highest locality outside Alaska is 33.5%. In 68 of the 109 localities, the surgeon receives less than the national amount.
For a spine group with offices in more than one Medicare locality, this means the same surgeon doing the same fusion can be paid different amounts depending on where the case is performed. In Illinois alone, the Chicago locality pays $132.60 more per case than suburban Chicago.
The order also changes. For this procedure, Chicago and Miami pay more than Manhattan, and Alaska, which tops the list for every joint replacement, falls below three other localities. Los Angeles pays only $35.23 above the national figure.
These are fee schedule amounts, before deductibles, coinsurance and adjustments outside the file. Your remittance data shows what your practice actually collects.
Co-surgeon and other indicators
The CMS row for this procedure sets these payment rules:
- Co-surgeons: indicator 2, which the readme defines as “Co-surgeons permitted and no documentation required if the two-specialty requirement is met.” For the joint replacements on these pages the indicator is 1, which requires documentation.
- Bilateral: indicator 0. The 150% bilateral adjustment does not apply to this procedure.
- Multiple procedures on one day: standard rules. The highest-valued procedure is paid in full and the next ones at 50%, which would be $802.46 for a procedure with this value at the national rate.
- Assistant at surgery: may be paid.
- Team surgery: not permitted.
What the fee includes
The procedure has a 90-day global period. CMS describes this as major surgery with a one-day preoperative period and a 90-day postoperative period included in the fee schedule amount.
| Part of the global package | Share | National dollars |
|---|---|---|
| Preoperative | 10% | $160.49 |
| Intraoperative, including in-hospital post-op work | 69% | $1,107.39 |
| Postoperative office care after discharge | 21% | $337.03 |
The facility side
The hospital or surgery center is paid separately for the same case under rates in CMS addenda that carry an AMA license agreement, so those tables are not used here.
The CY 2026 outpatient final rule in the Federal Register states that CMS is “phasing out the IPO list over 3 years,” starting with 285 mostly musculoskeletal services in 2026, and adds 276 procedures to the surgery center covered procedures list under revised criteria (Federal Register, CMS-1834-FC). Whether a specific spine procedure is on either list for your site is a question for your coding team and the published addenda.
The facts side by side
The 2026 national Medicare surgeon payment for a single-level ACDF is $1,604.91.
Malpractice is 17.1% of that fee, against 11.6% for a total knee.
The same case pays $1,392.81 in Wisconsin and $2,046.86 in Miami.
Co-surgeons from two specialties can be paid without extra documentation.
In one orthopedic practice I audited, 92% of the Google Ads spend went to a campaign that had produced zero appointments, and the appointment buttons led to a page with no form.
What those mean together for your practice is for you to work out.
If you want a second view on what a spine case costs you to win in your market, book a 30-minute call. I will look at your site and your market before we talk.
Related pages
The patient-facing price side is on ACDF cervical fusion cost and lumbar fusion surgery cost. For spine marketing spend, see Google Ads for spine surgeons cost and orthopedic patient acquisition cost.
Method
I took the procedure’s work, facility practice expense and malpractice RVUs from the CMS 2026 national relative value file, October release, and the three geographic indices for all 109 localities from Addendum E in the same download. For each locality, each RVU is multiplied by its index, the results are added, and the sum is multiplied by $33.4009, the facility formula in the CMS readme. With all indices at 1.0 the output equals the national amount. The CMS physician fee schedule look-up tool returns the same figures.
Frequently asked questions
What does Medicare pay a surgeon for a single-level ACDF in 2026? $1,604.91 nationally in the facility setting, from 48.05 RVUs at $33.4009. At the alternative payment model conversion factor of $33.5675, it is $1,612.92.
Why does ACDF reimbursement vary so much by location? Malpractice is 17.1% of this procedure’s RVUs, and CMS adjusts malpractice by a locality index that varies widely. The payment runs from $1,392.81 in Wisconsin to $2,046.86 in Miami, a 47.0% spread.
Can two surgeons both be paid for an ACDF? The CMS file marks the procedure as co-surgeon indicator 2: co-surgeons are permitted with no documentation required if the two-specialty requirement is met.
Is follow-up care included? Yes. Routine care during the 90-day global period is included in the fee.
Does this include the hospital or surgery center payment? No. It covers only the surgeon’s payment under the physician fee schedule.
