Anterior osteotomy of a single cervical vertebral segment, performed via an anterior surgical approach to realign or decompress the cervical spine.
Verified May 8, 2026 · 5 sources ↓
- Medicare
- $1,558.82
- Total RVUs
- 46.67
- Global, days
- 90
- Region
- Spine
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 5 cited references ↓
- Specify the vertebral level(s) by name (e.g., C4-C5) — 'cervical spine' alone is insufficient for audit defense.
- Document the surgical approach explicitly as anterior; notes that omit approach are a common audit flag.
- State the deformity or pathology being corrected (e.g., cervical kyphosis, ankylosing spondylitis, post-laminectomy deformity) with supporting imaging correlation.
- Record the number of vertebral segments treated to support 22220 vs. additional 22226 add-on units.
- If modifier 22 is used for increased complexity, the operative note must quantify additional work and explain why (e.g., prior surgery, severe ankylosis, calcified ligaments).
- Document all implants and instrumentation placed in the same session to support separately billed add-on codes.
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 5 cited references ↓
CPT 22220 describes an anterior approach osteotomy of one cervical vertebral segment. The procedure involves cutting through vertebral bone from an anterior exposure to correct deformity, restore alignment, or relieve neural compression in the cervical spine. Common indications include cervical kyphosis, fixed cervical deformity secondary to ankylosing spondylitis, post-laminectomy kyphosis, and severe spondylolisthesis that cannot be addressed posteriorly.
This is a 90-day global procedure. The global period covers the day-before visit, the surgery itself, and all routine postoperative management through day 90. Any E/M visit during that window for an unrelated problem requires modifier 24. If the decision for surgery is made at a same-day E/M, append modifier 57 to the E/M code — not to 22220. Additional vertebral segments at the same level family are reported with add-on code 22226 for each additional cervical segment.
Fluoroscopy used intraoperatively to guide the osteotomy is generally considered integral to spinal surgical procedures and is not separately billable per NCCI policy. When instrumentation (e.g., anterior cervical plate) is placed at the same session, the appropriate instrumentation add-on codes (e.g., 22845) may be reported separately. Always verify NCCI PTP edits before stacking codes; several spinal reconstruction codes bundle into 22220 without a modifier bypass.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
| Work RVU | 22.37 |
| Practice expense RVU | 17.24 |
| Malpractice RVU | 7.06 |
| Total RVU | 46.67 |
| Medicare national rate | $1,558.82 |
| 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 | $1,558.82 |
HOPD (APC 5114) Hospital outpatient department | $7,413.38 |
ASC (PI J8) Ambulatory surgical center (freestanding) | $6,248.35 |
Common denial reasons
The recurring reasons claims for CPT 22220 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Medical necessity not established — missing imaging reports or inadequate documentation of failed conservative treatment prior to surgical intervention.
- Unbundling errors — separately billing fluoroscopy or other guidance that NCCI considers integral to the spinal osteotomy.
- Incorrect unit count — billing 22220 multiple times for additional segments instead of using add-on code 22226 for each additional cervical segment.
- Global period violations — postoperative E/M visits billed without modifier 24 when the visit is for an unrelated condition during the 90-day global.
- Missing or vague operative note — failure to name the approach, vertebral level, or deformity type prevents accurate code validation on review.
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 5 cited references ↓
01When do I add 22226 versus billing 22220 again?
02Is fluoroscopy bundled into 22220 or separately billable?
03Can I bill anterior cervical plating (22845) with 22220 on the same day?
04What modifier applies if the surgeon makes the decision for surgery at the same-day E/M visit?
05Can two surgeons co-operate on 22220 and both bill?
06If the patient returns within 90 days for an unplanned revision related to the osteotomy, what modifier applies?
07Is 22220 on CMS's inpatient-only list?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/files/document/04-chapter4-ncci-medicare-policy-manual-2026-final.pdf
- 03cms.govhttps://www.cms.gov/files/document/r13573cp.pdf
- 04aaos.orghttps://www.aaos.org/globalassets/quality-and-practice-resources/coding-and-reimbursement/resident-guide/resident-guide_modifiers.pdf
- 05aapc.comhttps://www.aapc.com/codes/cpt-codes/22220
Mira AI Scribe
Mira's AI scribe captures the surgical approach (anterior), the specific vertebral level(s) treated, the pathology driving the osteotomy, and all instrumentation placed during the same session. That detail prevents the two most common 22220 denials: vague operative notes that can't support medical necessity on audit, and unbundling flags when implant add-ons lack same-session documentation.
See how Mira captures CPT 22220 documentation