Fusion · Spine

Posterior or posterolateral osteotomy of a single thoracic vertebral segment to correct spinal deformity

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,455.95
Total RVUs: 43.59
Global, days: 90
Region: Spine

Drawn from AAPCCMSNIHNervesSrs

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify approach by name: posterior or posterolateral — do not use 'standard approach'
Document the specific thoracic level(s) operated on (e.g., T4, T7-T8)
Identify the spinal deformity diagnosis driving the osteotomy (e.g., scoliosis, kyphosis) with supporting imaging
If billing +22216, document each additional segment treated and confirm contiguous vs. non-contiguous levels
If modifier 22 is appended, document increased operative time, unusual anatomy, or complexity beyond typical in the operative note
Separate documentation for any concurrently reported arthrodesis, instrumentation, or bone graft procedures

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 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 22212 covers a posterior or posterolateral bony incision of one thoracic vertebral segment performed to realign the spine and address structural deformity. The approach goes through the back, allowing the surgeon to cut and reposition the vertebral bone. This is a technically demanding procedure that carries a 90-day global period under CMS, covering all routine postoperative care through day 90.

For additional thoracic vertebral segments treated at the same operative session, report add-on code +22216 — one unit per additional segment. When osteotomy levels are contiguous, the primary code governs the first segment and +22216 covers each subsequent one. Non-contiguous levels in different spinal regions may support separate primary code reporting per NCCI policy, but contiguous levels do not. Payers scrutinize 22212 closely when billed alongside interbody arthrodesis codes (22630, 22633): a documented deformity must support the osteotomy independently of any laminectomy already bundled into a fusion code.

Arthrodesis, bone grafting, and instrumentation codes may be reported separately when performed and documented. Fluoroscopy integral to the procedure is not separately billable. Modifier 22 applies when complexity is substantially above typical — document the increased time, difficulty, or unusual anatomical findings in the operative note to support it.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	20.47
Practice expense RVU	16.78
Malpractice RVU	6.34
Total RVU	43.59
Medicare national rate	$1,455.95
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	$1,455.95
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,677.95

Common denial reasons

The recurring reasons claims for CPT 22212 get rejected.

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

Osteotomy coded without documented structural deformity — laminectomy bundled into fusion is not sufficient justification
22212 reported with 22214 at the same level without appropriate modifier — NCCI bundling applies across the osteotomy family
Missing or vague level specification in the operative note triggers medical necessity and audit flags
Fluoroscopy billed separately when integral to the spinal procedure — not separately payable under NCCI policy
Global period violations: postoperative visits billed without modifier 24 or 79 within the 90-day window when unrelated

Frequently asked questions

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

01What add-on code covers additional thoracic segments in the same session?

Report +22216 for each additional vertebral segment. List it separately in addition to 22212 as the primary procedure code.

02Can 22212 be billed with posterior interbody fusion codes like 22630 or 22633?

Yes, but with caution. NCCI edits and payer policy flag this combination. The osteotomy must address a documented spinal deformity that exists independently of any laminectomy already bundled into the fusion. Billing without that deformity-specific documentation is a common audit trigger, per Scoliosis Research Society and neurosurgery coding guidance.

03Is fluoroscopy separately billable with 22212?

No. Under NCCI policy, fluoroscopy integral to a spinal surgical procedure is not separately reportable.

04How do I handle 22212 when operating on non-contiguous thoracic and lumbar levels through separate incisions?

Per NCCI Chapter 4, non-contiguous levels in different spinal regions accessed through separate incisions may support separate primary procedure codes — 22212 for the thoracic segment and 22214 for the lumbar segment, for example. Contiguous levels do not support separate primary codes.

05What modifier applies when a related complication requires a return to the OR within the 90-day global?

Use modifier 78 for an unplanned return to the OR for a complication related to the original procedure. Modifier 79 is for an unrelated procedure in the global period — do not use them interchangeably.

06Does modifier 62 apply to 22212?

Modifier 62 can apply when two surgeons perform distinct portions of the osteotomy as co-surgeons. Both operative notes must document each surgeon's distinct role and the medical necessity for the co-surgery arrangement.

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(s) by name, the approach (posterior vs. posterolateral), the deformity diagnosis, the number of vertebral segments addressed, and any concurrent procedures from surgeon dictation. That specificity prevents the two most common denial triggers: missing level documentation and osteotomy claims that can't be separated from laminectomy work already bundled into a fusion code.

See how Mira captures CPT 22212 documentation