Fusion · Spine

Three-column lumbar spinal osteotomy performed via a posterior or posterolateral approach on a single vertebral segment, involving removal of a wedge of bone to correct fixed sagittal or coronal deformity in the lumbar spine.

Verified May 8, 2026 · 7 sources ↓

Medicare: $2,214.48
Total RVUs: 66.3
Global, days: 90
Region: Spine

Drawn from CMSAAPCFindacodeGuidelinesFiles

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Name the specific osteotomy type (e.g., pedicle subtraction osteotomy, vertebral column resection) — do not write 'three-column osteotomy' alone.
Identify the exact vertebral level operated on (e.g., L3) and confirm all three columns were addressed through a posterior or posterolateral approach.
Document the degree of angular correction achieved and the preoperative versus postoperative deformity measurements (e.g., sagittal balance parameters, Cobb angle).
Record estimated blood loss, operative time, and any intraoperative neuromonitoring used — these support medical necessity and modifier 22 if complexity was substantially increased.
Include the clinical indication: fixed sagittal imbalance, flatback deformity, rigid scoliosis, or kyphoscoliosis unresponsive to lesser osteotomy techniques.
If modifier 62 is billed, each co-surgeon must submit a separate operative note documenting their distinct portion of the procedure.
Prior authorization documentation from the ordering provider should be retained, as commercial payers (e.g., Carelon/Anthem) apply formal spine surgery appropriateness criteria to this code.

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 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 7 cited references ↓

CPT 22207 covers a posterior or posterolateral three-column osteotomy of one lumbar vertebral segment — the type of resection classically described as a pedicle subtraction osteotomy (PSO) or vertebral column resection (VCR). All three columns of the spine are disrupted through a single posterior exposure: the posterior elements, the pedicles, and a portion of the vertebral body are resected to allow angular correction of the spine. This is among the most technically demanding procedures in spine surgery and is used when fixed deformity cannot be corrected by soft-tissue releases or posterior column osteotomies alone. Primary indications include fixed lumbar kyphosis, severe flatback deformity, and rigid scoliosis or kyphoscoliosis requiring correction in the lumbar region.

22207 carries a 90-day global period. Fusion codes (e.g., 22612, 22630), instrumentation codes, bone grafting, and neuromonitoring are commonly reported alongside it — each with its own bundling rules and NCCI considerations. If a second vertebral segment requires the same three-column resection, report 22208 as an add-on. For two-surgeon cases, modifier 62 applies when each surgeon performs distinct portions of the procedure and separate operative notes document that division of work. Payers — particularly Carelon/Anthem — require prior authorization and apply formal clinical appropriateness criteria to spinal deformity surgery under their Spine Surgery guidelines, so confirm requirements before scheduling.

Documentation must be granular. Audit reviewers expect the operative note to name the specific osteotomy type (PSO, VCR), the vertebral level, estimated blood loss, intraoperative neuromonitoring use, and the degree of angular correction achieved. Failure to specify the exact vertebral level and three-column involvement is the leading cause of downcoding or denial on 22207 claims.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	35.76
Practice expense RVU	19.61
Malpractice RVU	10.93
Total RVU	66.3
Medicare national rate	$2,214.48
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	$2,214.48
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 22207 get rejected.

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

Operative note does not specify that all three spinal columns were resected, leading payers to downcode to a lesser osteotomy code.
Missing or insufficient prior authorization — commercial payers treating 22207 under spinal deformity appropriateness guidelines deny without it.
Lack of documented failed conservative or surgical alternatives, which payers use to establish medical necessity for a three-column resection.
Incorrect use of modifier 62 without separate co-surgeon operative notes, causing the second surgeon's claim to deny.
Vertebral level not specified in the operative note, triggering medical record requests and potential downcoding on audit.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01What is the difference between 22207 and 22206?

22206 covers a three-column osteotomy of the thoracic spine; 22207 is the lumbar equivalent. Select the code based on the vertebral level operated on, not the approach.

02When do I add 22208 to a 22207 claim?

22208 is the add-on code for each additional vertebral segment requiring a three-column osteotomy in the same session. Report it once per additional segment beyond the primary level billed under 22207.

03Can I bill 22207 with fusion codes in the same session?

Yes. Fusion (e.g., 22612, 22630), instrumentation, and bone grafting codes are routinely reported alongside 22207 when performed. Check NCCI edits for each pairing, and use modifier 59 or XS where a column edit applies and the services are genuinely distinct.

04Does 22207 require prior authorization from commercial payers?

Most major commercial payers — including those using Carelon/Anthem Spine Surgery appropriateness guidelines — require prior authorization for 22207. Confirm with each plan before scheduling; denial on auth grounds is difficult to overturn post-service.

05When does modifier 22 apply to 22207?

Modifier 22 is appropriate when documented factors substantially increase operative complexity beyond what the code typically represents — for example, severe osteoporosis requiring altered technique, extreme deformity, revision after prior multilevel fusion, or EBL significantly exceeding norms. The operative note must explicitly describe those factors; a high RVU code alone does not justify modifier 22.

06How does the 90-day global period affect billing for post-op complications?

Routine post-op care through day 90 is included in the global. If the patient returns to the OR for a complication related to the osteotomy, bill with modifier 78. If the return procedure is unrelated to the original surgery, use modifier 79. Do not use modifier 24 for an office visit in the global window unless it is clearly unrelated to the spinal surgery.

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 osteotomy type by name (PSO, VCR), the specific lumbar vertebral level, all three-column involvement, estimated blood loss, degree of angular correction, and neuromonitoring status directly from surgeon dictation. That structured output prevents the most common audit flag on 22207 — an operative note that confirms a big case happened but fails to document the three-column specificity payers require to pay the code.

See how Mira captures CPT 22207 documentation