Partial removal of a posterior cervical vertebral element — spinous process, lamina, or facet — to excise an intrinsic bony lesion at a single vertebral segment.
Verified May 8, 2026 · 4 sources ↓
- Medicare
- $994.34
- Total RVUs
- 29.77
- Global, days
- 90
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Specify the exact posterior element excised — spinous process, lamina, or facet — not just 'posterior decompression'
- Identify the vertebral level by name (e.g., C4) and confirm it is a single cervical segment
- Document the pathological diagnosis driving excision — intrinsic bony lesion must be the operative indication, not adjacent nerve compression alone
- Include pre-op imaging (CT or MRI) correlating the bony lesion to the operative level
- Note whether intraoperative fluoroscopy was used and whether it is integral to the procedure or separately reportable per CPT instruction
- If modifier 22 is appended, quantify increased complexity — unusual anatomy, bleeding, prior surgery at level — in the operative note
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
CPT 22100 covers surgical excision of part of the posterior bony architecture of a single cervical vertebra — specifically the spinous process, lamina, or facet — when the indication is an intrinsic bony lesion contained within that segment. The target pathology is the bone itself (e.g., osteoid osteoma, osteoblastoma, or other primary osseous lesion), not adjacent disc or soft tissue. That distinction drives code selection: if the primary goal is decompression rather than lesion excision, a laminectomy or laminotomy code is the correct vehicle.
NCCI policy is explicit: 22100 cannot be billed separately with a laminectomy or laminotomy code for the same vertebra. Fluoroscopy (76000) is bundled into spinal procedures and is not separately reportable unless a specific CPT instruction says otherwise. When additional cervical segments are treated, add-on code 22103 covers each additional segment beyond the first. For thoracic and lumbar analogues, use 22101 and 22102 respectively.
The 90-day global period means all routine post-op management through day 90 is included in the surgical payment. Separate E/M visits during that window require modifier 24 (unrelated condition) or modifier 25 if billed on the day of a minor procedure. Unplanned returns to the OR for a related complication bill with modifier 78; unrelated procedures in the global window use modifier 79.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 10.73 |
| Practice expense RVU | 14.53 |
| Malpractice RVU | 4.51 |
| Total RVU | 29.77 |
| Medicare national rate | $994.34 |
| Global period | 90 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $994.34 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI G2) Ambulatory surgical center (freestanding) | $3,695.53 |
Common denial reasons
The recurring reasons claims for CPT 22100 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Bundling denial when 22100 is billed alongside a laminectomy or laminotomy code for the same vertebral level — NCCI prohibits separate reporting
- Medical necessity denial when the operative note frames the indication as decompression rather than intrinsic bony lesion excision
- Incorrect code selection: using 22100 for thoracic or lumbar segments instead of 22101 or 22102
- Missing or non-specific pathology: payers deny when documentation does not identify a discrete bony lesion consistent with the code descriptor
- Unbundling fluoroscopy (76000) separately without a CPT-specific instruction authorizing it for this procedure
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Can I bill 22100 and a laminectomy code together for the same vertebra?
02What add-on code covers additional cervical segments in the same session?
03How does 22100 differ from 22101 and 22102?
04Is fluoroscopy separately billable with 22100?
05When is modifier 22 appropriate for 22100?
06Does the 90-day global period affect post-op visits after cervical lesion excision?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
Mira AI Scribe
Mira's AI scribe captures the specific posterior element removed (spinous process, lamina, or facet), the named cervical vertebral level, and the operative indication as an intrinsic bony lesion — not decompression. It also flags concurrent laminectomy or laminotomy documentation at the same level, which triggers an NCCI bundling conflict that auditors and clearinghouses catch on submission.
See how Mira captures CPT 22100 documentation