Surgical · Spine

Partial excision of a posterior lumbar vertebral component — such as the spinous process, lamina, or facet — to remove an intrinsic bony lesion at a single vertebral segment.

Verified May 8, 2026 · 8 sources ↓

Medicare: $702.09
Total RVUs: 21.02
Global, days: 90
Region: Spine

Drawn from CMSAAPCMdclarityPayerpriceFindacode

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 8 cited references ↓

Specify the exact posterior vertebral component excised — spinous process, lamina, or facet — not just 'posterior element'
Identify the lumbar level (e.g., L3) and confirm single-segment involvement; multi-level resections require additional units or codes
Pathology or imaging confirming an intrinsic bony lesion (not a herniated disc or soft-tissue mass) driving the excision
Operative note must distinguish this procedure from a standard decompressive laminectomy — the indication is lesion removal, not neural decompression
If modifier 22 is appended, document specifically what made the work substantially greater than typical (e.g., extensive tumor involvement, altered anatomy, significant bleeding)

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 22102 covers surgical removal of a portion of the posterior lumbar vertebral architecture (spinous process, lamina, or facet) when the target is an intrinsic bony lesion confined to a single lumbar segment. The code is lumbar-specific — cervical and thoracic equivalents are 22100 and 22101 respectively. Typical indications include osteoid osteoma, aneurysmal bone cyst, or other primary bony pathology arising within the posterior vertebral elements. This is not the correct code for a standard laminectomy performed to decompress neural elements, nor for lesions that extend into the vertebral body.

The 90-day global period means all routine post-operative management through day 90 is bundled into the payment. Any E/M visit for an unrelated condition in that window requires modifier 24. If the decision for this surgery was made the day of or day before a major E/M service, append modifier 57 to the E/M. Multiple-level resections at separate vertebral segments are each reportable — MUE logic caps lumbar spine units at 5, matching the five available lumbar levels.

Top billing specialties in the CMS PUF are anesthesiology, pain management, and physical medicine and rehabilitation, which reflects use in tumor and pain-related contexts rather than routine spine decompression. Site of service matters: HOPD and ASC payments differ substantially — see the site-of-service comparison table on this page.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	10.8
Practice expense RVU	8.47
Malpractice RVU	1.75
Total RVU	21.02
Medicare national rate	$702.09
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	$702.09
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 22102 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Code billed as a decompression laminectomy without documentation of an intrinsic bony lesion, triggering medical necessity denial
Incorrect level or region — using 22102 when the operated level is cervical (22100) or thoracic (22101)
Missing or vague pathology documentation; payers require evidence of a discrete bony lesion, not just 'mass' or 'overgrowth'
Bundling denial when billed same-day with a related decompression code without modifier 59 to establish a distinct procedural service
Units exceeding MUE limits — more than 5 units reported for lumbar-level procedures, which CMS caps at the number of available lumbar vertebrae

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What separates 22102 from a standard laminectomy code?

22102 requires an intrinsic bony lesion as the surgical target. Standard decompressive laminectomies performed to relieve disc or stenosis pressure on neural elements use separate codes (e.g., 63030, 63047). The distinction must be explicit in the operative note.

02Can 22102 be billed for multiple lumbar levels in the same session?

Yes. Each additional lumbar segment with a distinct bony lesion resection is separately reportable. CMS MUE logic caps lumbar vertebral procedure units at 5, matching the five lumbar levels. Document each level clearly in the operative note.

03Which modifier applies if two surgeons each perform distinct portions of the procedure?

Both surgeons append modifier 62 to 22102. Each bills the same code, and reimbursement is split. The operative note must document each surgeon's distinct role.

04Is modifier 59 needed when 22102 is billed with another spine code on the same day?

Often yes. If the procedures could otherwise be bundled under NCCI edits, modifier 59 documents that the services were distinct — either at a different anatomic site or through a separate indication. Review NCCI PTP edits for the specific code pairing before appending.

05What does the 90-day global period cover for 22102?

All routine post-operative care from the day before surgery through day 90 is bundled — office visits, wound checks, and stitch removals. Bill modifier 24 on any E/M for an unrelated condition during that window, and modifier 78 for an unplanned return to the OR for a related procedure.

06Why do anesthesiology and pain management top the PUF billing data for this code?

22102 is frequently used in tumor and pain-related contexts — osteoid osteoma ablation, aneurysmal bone cysts — where pain management and physiatry specialists are involved in the care pathway, not just orthopedic or neurosurgeons performing routine spine decompressions.

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 vertebral component excised (spinous process, lamina, or facet), the lumbar level, and the documented intrinsic bony lesion diagnosis directly from surgeon dictation. That prevents the most common audit flag on 22102 — operative notes that describe a decompression approach without anchoring the indication to a discrete bony pathology, which draws medical necessity denials and downcoding to a standard laminectomy code.

See how Mira captures CPT 22102 documentation