Fusion · Spine

Posterior or posterolateral spinal osteotomy of a single lumbar vertebral segment — a bone-cutting procedure used to correct sagittal or coronal plane deformity in the lumbar spine.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,444.25
Total RVUs: 43.24
Global, days: 90
Region: Spine

Drawn from CMSUnitedHealthcare MedicareMedtronic 2026Carelon ClinicalScoliosis Research

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Identify the specific osteotomy technique by name (e.g., Smith-Petersen, Ponte) — 'standard posterior osteotomy' is insufficient for audit defense
State the exact lumbar level(s) treated and confirm only one segment was osteotomized under this code
Document pre- and post-correction alignment measurements (sagittal vertical axis, lumbar lordosis angle) to justify medical necessity
Include imaging studies (standing scoliosis films, MRI, CT) that demonstrate the fixed deformity requiring osteotomy rather than flexible correction
Record intraoperative neuromonitoring use and any changes in evoked potentials, as this is expected for high-risk osteotomies
Note estimated blood loss and any intraoperative complications, which support modifier 22 if substantially increased complexity occurred
If a co-surgeon was used (modifier 62), both operative notes must independently describe distinct surgical tasks performed

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 8 cited references ↓

CPT 22214 describes a posterior or posterolateral osteotomy of one lumbar vertebral segment. The procedure involves surgically cutting through the posterior elements of a single lumbar vertebra to allow controlled realignment of the spinal column — most commonly performed for fixed sagittal imbalance, post-laminectomy kyphosis, or rigid scoliosis where instrumented fusion alone cannot restore alignment. This is a single-column or partial osteotomy construct (e.g., Smith-Petersen or Ponte osteotomy); three-column resections such as pedicle subtraction osteotomy are captured by 22207. When additional lumbar segments require osteotomy in the same session, report 22216 as an add-on code for each additional segment.

The 90-day global period means all routine post-op management — wound checks, hardware monitoring visits, suture removal — is bundled through day 90. Any unrelated procedure during that window requires modifier 79; an unplanned return to the OR for a complication related to the osteotomy requires modifier 78. When a significant co-surgeon contributes distinct portions of the procedure, modifier 62 may apply, though payer acceptance varies and documentation must support separate skill sets. Assistant surgeon billing uses modifier 80 or AS for non-physician practitioners.

This code appears on UnitedHealthcare Medicare Advantage's covered lumbar spine surgery list effective 01/01/2026 and carries ASC payment indicator J8 under the 2026 OPPS/ASC final rule, meaning it is covered in the ASC setting. Operative documentation must be granular: osteotomy technique by name, levels involved, degree of correction achieved, and intraoperative neuromonitoring status, because high-RVU spinal osteotomies are a consistent RAC and commercial audit target.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	20.49
Practice expense RVU	16.58
Malpractice RVU	6.17
Total RVU	43.24
Medicare national rate	$1,444.25
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	$1,444.25
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI J8) Ambulatory surgical center (freestanding)	$5,666.81

Common denial reasons

The recurring reasons claims for CPT 22214 get rejected.

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

Medical necessity not established — payer requires documented failed conservative care and standing deformity imaging before approving a lumbar osteotomy
Unbundling conflict — billing 22214 with 22207 at the same level on the same day; three-column subtraction osteotomy is separately coded and the two are mutually exclusive at the same segment
Global period violation — post-op visit or repeat imaging billed without modifier 24 during the 90-day global window
Lack of prior authorization — most commercial payers and Medicare Advantage plans, including UHC, require PA for elective lumbar osteotomy
Operative note does not name the osteotomy technique or level, causing clinical reviewers to flag the note as insufficient to support the high-RVU code
Modifier 62 co-surgeon claim denied because the second surgeon's note does not document a distinct, separately identifiable portion of the procedure

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the difference between 22214 and 22207?

22214 covers a posterior or posterolateral osteotomy through one or two columns of a single lumbar segment (e.g., Smith-Petersen, Ponte). 22207 is reserved for a three-column resection — pedicle subtraction or vertebral body subtraction — at a lumbar segment. They are mutually exclusive at the same level on the same day; bill the code that matches what was actually done.

02Can I bill 22214 with 22216 if I perform osteotomies at multiple lumbar levels?

Yes. 22214 is the primary code for the first lumbar segment. 22216 is the add-on code for each additional segment osteotomized via the same posterior or posterolateral approach in the same session. Report one unit of 22216 per additional segment.

03Does 22214 require prior authorization from commercial payers?

Most commercial payers and Medicare Advantage plans treat elective lumbar osteotomy as a prior-auth procedure. UnitedHealthcare Medicare Advantage lists 22214 as a covered lumbar spine surgery code effective 01/01/2026, but coverage does not eliminate the PA requirement. Confirm auth before scheduling.

04How does the 90-day global period affect billing after a lumbar osteotomy?

All routine post-op E/M visits, wound management, and hardware surveillance within 90 days are bundled. Bill unrelated E/M services with modifier 24, unrelated procedures with modifier 79, and unplanned returns to the OR for related complications with modifier 78. Missing a modifier on a same-physician claim during the global period will trigger an automatic denial.

05When is modifier 22 appropriate for CPT 22214?

Use modifier 22 when the osteotomy required substantially greater work than typical — for example, severe ankylosis, revision after prior instrumented fusion at the same level, or significant intraoperative bleeding requiring extended OR time. The operative note must document what drove the increased complexity; a generic 'difficult case' notation will not survive a payer audit.

06Is 22214 payable in the ASC setting under Medicare?

Yes. CMS assigns 22214 payment indicator J8 under the 2026 OPPS/ASC final rule, meaning it is on the ASC covered procedures list. The ASC payment rate differs from the HOPD rate — see the site-of-service comparison on this page for current figures.

Sources & references

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

01CMS Physician Fee Schedule 2026
02CMS OPPS/ASC 2026 Final Rule CMS-1834-FC — https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient/regulations-notices/cms-1834-fc
03UnitedHealthcare Medicare Advantage Spine Procedures Medical Policy, Effective 01/01/2026 — https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-mp/spine-procedures.pdf
04Medtronic 2026 Billing and Coding Guide: Spinal Procedures — https://www.medtronic.com/content/dam/medtronic-wide/public/united-states/customer-support-services/reimbursement/spinal-procedures-billing-and-coding-guide.pdf
05CMS NCCI Policy Manual Chapter 4 — https://www.cms.gov/files/document/chapter4cptcodes20000-29999final11.pdf
06Carelon Clinical Guidelines: Lumbar Fusion and Treatment of Spinal Deformity — https://guidelines.carelonmedicalbenefitsmanagement.com/spine-surgery-2024-10-20/
07Scoliosis Research Society Coding & Reimbursement Resource — https://www.srs.org/Education/Coding--Reimbursement
08MD Clarity CPT 22214 Reference — https://www.mdclarity.com/cpt-code/22214

Mira AI Scribe

Mira's AI scribe captures the osteotomy technique by name, the specific lumbar level, pre- and post-correction alignment measurements, estimated blood loss, neuromonitoring status, and whether a co-surgeon performed a distinct portion of the procedure. That detail prevents the two most common audit flags for 22214: an operative note that omits the technique name and a co-surgeon claim lacking evidence of separate surgical work.

See how Mira captures CPT 22214 documentation