Surgical · Spine

Partial excision of a single lumbar vertebral body for 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 AAPCCMSHealthPayerpriceMdclarity

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the lumbar vertebral level(s) treated (e.g., L2, L3) — level ambiguity is a common audit flag.
Confirm the lesion is intrinsic to the vertebral body; document pathology type (tumor, infection, metabolic bone disease) with imaging correlation.
State explicitly that spinal cord or nerve root decompression was NOT performed, or code to a different procedure if it was.
Operative note must identify this as a single-segment excision; if additional segments were resected, document each separately to support add-on code 22116.
If modifier 22 is applied, include a narrative in the operative note quantifying the increased complexity — time, blood loss, anatomical distortion, or prior surgery findings.
Inpatient admission orders and medical necessity documentation supporting IPO status are required; outpatient site-of-service for Medicare is a hard denial.

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 59 Distinct service 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22114 covers surgical removal of a portion of a lumbar vertebral body to address a lesion contained within the bone itself — think primary bone tumors, metastatic disease, or osteomyelitis confined to the vertebra. The critical distinction: no decompression of the spinal cord or nerve roots is performed. If decompression is also done, a different code applies. The procedure targets a single lumbar vertebral segment; add-on code 22116 captures each additional segment resected in the same session.

This is an inpatient-only (IPO) procedure under Medicare and most state Medicaid programs. CMS assigned it status indicator 'C', meaning it cannot be billed to Medicare in an ambulatory surgical center or hospital outpatient setting — any attempt will be denied. The 90-day global period applies: all routine follow-up visits, wound checks, and post-op management through day 90 are bundled. Separate E&M visits during that window require modifier 24 (unrelated condition) or modifier 25 doesn't apply post-op — use modifier 24 only.

Billing 22114 alongside fusion, instrumentation, or decompression codes in the same session is common and generally payable, but NCCI edits govern specific pairings. Document each procedure separately and use modifier 59 or the appropriate XS modifier to distinguish distinct services when an edit fires. Modifier 22 is warranted when operative complexity significantly exceeds the typical case — extensive tumor involvement, revision anatomy, or hemorrhage — but requires a detailed operative note explaining the added work, not just a checkbox.

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 22114 get rejected.

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

Site-of-service mismatch: 22114 is inpatient-only under Medicare; billing it in an ASC or outpatient hospital setting results in automatic denial.
Decompression performed but not separately coded — or conversely, decompression coded when the operative note describes only vertebral body excision.
Missing or vague vertebral level documentation, causing medical necessity or specificity denials.
NCCI bundling edits triggered when 22114 is billed same-session with adjacent procedures without a valid modifier distinguishing the distinct services.
Modifier 22 denied for lack of supporting operative note narrative — a higher charge alone is insufficient justification.

Frequently asked questions

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

01Can 22114 be performed in an ASC for Medicare patients?

No. CMS designates 22114 as inpatient-only (status indicator C). Medicare will deny any claim billed from an ASC or hospital outpatient department. The procedure must be performed and billed as an inpatient hospital stay.

02What is the add-on code when more than one lumbar vertebral segment is excised?

Use 22116 for each additional vertebral segment excised in the same session. Document each level in the operative note.

03Does 22114 include decompression of the spinal cord or nerve roots?

No. The code is explicitly limited to excision of an intrinsic vertebral body lesion without neural decompression. If decompression is also performed, code it separately with appropriate documentation distinguishing the two procedures.

04When is modifier 22 appropriate for 22114?

Apply modifier 22 when documented factors — extensive tumor involvement, severe bleeding, distorted anatomy from prior surgery — made the procedure substantially more complex than typical. The operative note must narrate the added work; payers will not accept the modifier on documentation alone.

05Can 22114 be billed on the same day as spinal fusion codes?

Yes, when both procedures are performed and documented. NCCI edits may bundle certain pairings, so review the edit table and append modifier 59 or XS where a distinct service needs to be separated.

06What diagnoses typically support medical necessity for 22114?

Primary vertebral tumors, spinal metastases, vertebral osteomyelitis, and benign intrinsic bony lesions are the most common supporting diagnoses. ICD-10 code specificity (tumor type, vertebral level) must match the operative findings documented in the note.

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 lumbar vertebral level, lesion type and extent, surgical approach, confirmation that no neural decompression was performed, number of vertebral segments resected, and any complexity factors (hemorrhage, prior surgery, tumor vascularity) from the operative dictation. This prevents the most common audit flags: missing level specificity, decompression ambiguity, and unsupported modifier 22 claims.

See how Mira captures CPT 22114 documentation