Surgical · Spine

Partial excision of a vertebral body for an intrinsic bony lesion, each additional vertebral segment beyond the primary level — reported as an add-on to the primary excision code.

Verified May 8, 2026 · 4 sources ↓

Medicare: $125.92
Work RVU: 2.26
Global, days
Region: Spine

Drawn from CMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 4 cited references ↓

Identify the primary procedure code (22100, 22101, or 22102) this add-on accompanies
Specify each additional vertebral level by anatomic designation (e.g., T8, L3) in the operative note
Document the intrinsic bony lesion type and confirm no spinal cord or nerve root decompression was performed at the additional level
Include pathology or imaging findings supporting medical necessity at each additional segment
Confirm the surgical approach and extent of bone removal at each additional level distinct from the primary segment

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 62 Co-surgeons 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 4 cited references ↓

CPT 22116 is an add-on code for partial vertebral body excision targeting an intrinsic bony lesion (without spinal cord or nerve root decompression) at each additional vertebral segment beyond the first. It cannot stand alone — it must be listed with the primary single-segment code (22100, 22101, or 22102, depending on region). The ZZZ global period means this code inherits the global period of its primary procedure, so all post-op billing rules flow from the parent code.

Because 22116 is an add-on, modifier 51 does not apply. Each distinct additional segment requires its own unit, but payers will scrutinize high unit counts — operative documentation must clearly identify each level treated by anatomic designation (e.g., T8, L2). Neurosurgery and orthopedic surgery are the dominant billing specialties per CMS utilization data.

Not payable in hospital outpatient (HOPD) or ASC settings as a separately packaged service — payment follows the primary procedure's facility rate. Payer policies on medical necessity for multi-level excisions vary; some commercial plans require pre-authorization when three or more levels are billed.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (2.26) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.77) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	2.26
Practice expense RVU	0.75
Malpractice RVU	0.76
Total RVU	3.77
Medicare national rate	$125.92
Global period	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	$125.92

Common denial reasons

The recurring reasons claims for CPT 22116 get rejected.

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

Billed without a primary excision code (22100/22101/22102) on the same claim
Operative note does not individually identify additional vertebral levels by name or number
Modifier 51 incorrectly appended — add-on codes are exempt from multiple-procedure reduction
Medical necessity not established for each additional level when multiple units are billed
Payer requires pre-authorization for multi-level vertebral excision and none was obtained

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 4 cited references ↓

01What is the primary code that must accompany 22116?

22116 must be reported with 22100 (cervical/thoracic), 22101 (thoracic), or 22102 (lumbar) as the primary single-segment excision code. The correct primary depends on the region of the first level treated. Without a qualifying primary code on the same claim, 22116 will deny.

02Can you bill multiple units of 22116 for three additional levels?

Yes — one unit per additional segment beyond the primary. If the primary is at L2 and you also excise L3 and L4, bill 22116 x2. Each level must be individually documented by anatomic designation in the operative note or payers will reduce to one unit.

03Should modifier 51 be appended to 22116?

No. CPT add-on codes are exempt from modifier 51. Appending it is an error and may trigger incorrect payment reduction. Some clearinghouses flag it automatically — confirm your billing system excludes modifier 51 from all add-on codes.

04What does the ZZZ global period mean for post-op billing?

ZZZ means 22116 has no independent global period — it inherits the global period of the primary procedure it accompanies. If the primary carries a 90-day global, all routine post-op services for the combined procedure fall under that window.

05Is 22116 payable in an ASC or HOPD setting?

No separate ASC or HOPD payment rate applies to 22116. Payment in the facility setting is packaged into the primary procedure's facility reimbursement. Verify your facility billing aligns with the primary code's site-of-service payment rules.

06How does 22116 differ from codes in the decompression family like 63056?

22116 is specifically for partial excision of a vertebral body due to an intrinsic bony lesion — it explicitly excludes decompression of the spinal cord or nerve roots. If the operative goal was decompression, a different code family applies. Mixing intrinsic lesion excision codes with decompression codes for the same level at the same session will trigger NCCI scrutiny.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures each additional vertebral level treated by anatomic name directly from dictation — T-levels, L-levels, and S-levels logged individually. It also flags whether decompression language appears in the note, which would point to a different code family. This prevents the most common audit trigger: operative notes that reference 'additional levels' without naming them, which payers treat as insufficient support for each 22116 unit billed.

See how Mira captures CPT 22116 documentation