Fusion · Spine

Posterior or posterolateral osteotomy of a single cervical vertebral segment, involving cutting and removing a portion of the vertebra to correct spinal deformity.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,713.47
Total RVUs: 51.3
Global, days: 90
Region: Spine

Drawn from CMSSrsGuidelinesCgsmedicareAAPC

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify posterior or posterolateral approach explicitly — do not use 'standard approach' language
Identify the exact cervical vertebral level(s) treated (e.g., C5, C6)
Document the osteotomy type (posterior column osteotomy vs. PSO) and extent of bone removal
Record the deformity diagnosis, severity measurements (e.g., Cobb angle, sagittal balance parameters), and failure of conservative management
Describe each separately billed procedure (fusion, instrumentation, decompression) with distinct operative detail to support separate coding
Include intraoperative neuromonitoring documentation if separately reported

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 22210 covers a posterior or posterolateral spinal osteotomy at a single cervical vertebral segment. The surgeon accesses the spine from behind, cuts and removes a portion of the vertebral bone and its associated articular processes, then re-aligns the cervical spine as part of deformity correction. This is a posterior column osteotomy — distinct from the three-column pedicle subtraction osteotomy codes introduced in 2008. If additional vertebral segments require the same procedure at the same operative session, report 22216 for each additional level.

When the cervical osteotomy crosses into the thoracic spine, the cross-coding question becomes which primary code applies. The convention is to report the code with the higher RVU as the primary code — 22210 carries higher RVUs than 22212, so it leads the claim when the predominant work is cervical. Fusion, instrumentation, and decompression codes may be reported separately when performed; they are additive to the osteotomy, not bundled into it.

The 90-day global period applies. All routine post-op visits, wound care, and stitch removals through day 90 are included. Unrelated services in that window require modifier 24 or 25. Given the complexity and RVU weight of this procedure, pre-authorization is standard practice across commercial payers and documentation of deformity severity, prior conservative treatment failure, and the specific osteotomy technique is critical to withstand audit.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	24.75
Practice expense RVU	18.44
Malpractice RVU	8.11
Total RVU	51.3
Medicare national rate	$1,713.47
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	$1,713.47
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$4,682.29

Common denial reasons

The recurring reasons claims for CPT 22210 get rejected.

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

Missing or vague approach documentation — operative notes that omit posterior vs. posterolateral designation trigger audit flags
Incorrect level count when 22216 is billed for additional segments without clear per-level documentation
Bundling disputes when fusion and instrumentation add-on codes lack distinct operative documentation separate from the osteotomy narrative
Medical necessity denial when deformity severity metrics, conservative treatment history, or imaging findings are absent from the record
Authorization missing or obtained for incorrect procedure codes prior to surgery

Frequently asked questions

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

01When do I add 22216 to a claim with 22210?

Report 22216 for each additional vertebral segment treated with the same posterior osteotomy technique at the same session. Each level needs its own documented bone removal in the operative report — a blanket statement covering multiple levels is not enough.

02Can I bill fusion codes with 22210?

Yes. Arthrodesis codes (e.g., 22600 series) and instrumentation add-on codes are not bundled into 22210. Bill them separately with supporting documentation that describes the fusion work distinctly from the osteotomy work. Use modifier 51 where applicable.

03When the osteotomy crosses from cervical to thoracic, which code is primary?

Report 22210 (cervical) as the primary code when it carries the higher RVU, and 22212 (thoracic) or 22216 for the additional level. The general rule is to lead with the code representing the most extensive work — confirm with your MACs coding guidelines for cross-region spine cases.

04What distinguishes 22210 from the PSO codes introduced after 2008?

22210 covers single-column posterior osteotomies. The pedicle subtraction osteotomy (PSO) codes describe three-column resections. Prior to 2008, 22210 was used for both; coding now requires selecting the code that matches the actual osteotomy technique performed, so the operative note must name the specific procedure.

05How does the 90-day global period affect billing for post-op complications?

Unplanned return to the OR for a complication related to the original osteotomy during the 90-day global uses modifier 78. An unrelated procedure in the same window uses modifier 79. Routine post-op E/M visits are included in the global and cannot be separately billed without modifier 24.

06Is co-surgeon billing (modifier 62) appropriate for 22210?

Yes, cervical spine deformity cases often involve two surgeons with distinct roles (e.g., orthopedic and neurosurgery). Both surgeons append modifier 62 and each must document their individual contribution to the procedure to support the split payment.

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 approach (posterior vs. posterolateral), the specific cervical vertebral level, the extent of bone resection, deformity correction rationale, and each separately performed procedure (fusion level, instrumentation segments, decompression). That detail directly prevents the most common denials: vague approach language, level-count mismatches on 22216 add-ons, and insufficient medical necessity documentation for high-complexity deformity cases.

See how Mira captures CPT 22210 documentation