Surgical · Spine

Partial excision of a thoracic vertebral body to remove an intrinsic bony lesion, without decompression of the spinal cord or nerve roots.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,171.04
Total RVUs: 35.06
Global, days: 90
Region: Spine

Drawn from CMSFindacodeAAOSMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Operative note must name the specific thoracic vertebral level(s) treated (e.g., T6, T7).
Pathology or imaging confirming an intrinsic bony lesion — do not leave the indication implicit.
Explicit statement that spinal cord and nerve root decompression was NOT performed; absence of this distinction invites downcoding or audit.
Surgical approach documented by name (e.g., posterolateral, costotransversectomy, lateral extracavitary, transthoracic).
If modifier 62 is used, each surgeon's operative note must describe their distinct procedural work independently.
If modifier 22 is appended, documentation must quantify the additional work — time, complexity, altered anatomy, or unusual pathology — not just assert it.

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 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

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22112 describes surgical removal of a portion of a thoracic vertebral body to address a localized bony lesion — such as a tumor, infection, or osteonecrotic segment — when decompression of the spinal cord or nerve roots is not part of the procedure. The distinction from decompressive corpectomy codes is critical: 22112 is for intrinsic lesion excision only. If decompression is also performed, a different code applies.

This procedure carries a 90-day global period, meaning all routine post-op management through day 90 is bundled. Any same-day E/M service billed under the same physician requires modifier 25. If the decision for surgery was made the day of or day before the procedure during an E/M visit, append modifier 57 to that E/M. Co-surgery is common for this approach — when two surgeons perform distinct components (e.g., spine surgeon and thoracic access surgeon), both bill 22112 with modifier 62.

Because 22112 is performed almost exclusively in a hospital or ASC setting, site-of-service payment differences are material. NCCI bundling rules for spinal procedures are strict: instrumentation, bone grafting, and imaging guidance codes have specific add-on and standalone codes that must be billed correctly to avoid automatic bundling edits. Radiologic guidance is separately reportable only if the code descriptor for 22112 does not include it — verify per current NCCI policy.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	13.72
Practice expense RVU	15.57
Malpractice RVU	5.77
Total RVU	35.06
Medicare national rate	$1,171.04
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	$1,171.04
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 22112 get rejected.

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

Missing or vague indication: operative note doesn't clearly establish an intrinsic bony lesion distinct from degenerative disease.
Unbundling error: separately billing radiologic guidance when it is considered inclusive under NCCI policy for the same session.
Modifier 62 denied because one surgeon's note fails to document their distinct operative contribution.
Wrong code selected when decompression of cord or nerve roots was also performed — payer audits cross-reference op note against code descriptor.
Global period violations: billing routine post-op E/M within the 90-day window without modifier 24 for an unrelated visit.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01What is the difference between 22112 and a corpectomy code?

22112 is for partial excision of a thoracic vertebral body to remove an intrinsic bony lesion without spinal cord or nerve root decompression. Corpectomy codes involve vertebral body removal specifically to decompress neural structures. If decompression is the surgical goal, 22112 is the wrong code.

02Can two surgeons each bill 22112 for the same case?

Yes, when a spine surgeon and an access surgeon (e.g., thoracic surgery) each perform distinct portions of the procedure, both bill 22112 with modifier 62. Each surgeon's operative note must independently describe their distinct work — a shared or cosigned note is not sufficient.

03Is modifier 50 appropriate for 22112?

Theoretically applicable if bilateral vertebral body lesions are addressed, but this is exceedingly rare anatomy for a single thoracic level. Most payers will require medical necessity documentation and prior authorization before accepting a bilateral claim on a spinal vertebral body excision.

04How does the 90-day global period affect billing after a thoracic vertebral excision?

All routine post-op care through day 90 is bundled into 22112. E/M visits for unrelated problems require modifier 24. A staged or planned subsequent spinal procedure during that window requires modifier 58 and resets the global clock. An unplanned return to the OR for a related complication requires modifier 78.

05Can imaging guidance be billed separately with 22112?

Only if NCCI policy does not bundle the specific imaging guidance code with 22112 for the same session. Per CMS NCCI guidelines, if the primary code's descriptor or CMS instruction includes radiologic guidance, it cannot be separately reported. Verify the current NCCI edit pair before appending a guidance code.

06When should modifier 22 be used with 22112?

Append modifier 22 when the procedure required substantially greater work than typical — documented reasons include severe deformity, prior surgery altering the surgical field, morbid obesity, or unusually extensive lesion involvement. The operative note must quantify the additional effort; a blanket assertion of complexity will not survive audit.

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 thoracic level operated on, the lesion type and biopsy/pathology reference, the surgical approach by name, and an explicit statement that spinal cord or nerve root decompression was not performed. It also flags co-surgeon participation for modifier 62 pairing and logs intraoperative imaging use. This prevents the most common denial trigger for 22112: an operative note that omits the no-decompression distinction, which auditors use to challenge the code selection or bundle it with a decompression CPT.

See how Mira captures CPT 22112 documentation