Fusion · Spine

Anterior spinal osteotomy with discectomy performed on each additional vertebral segment beyond the primary segment, lumbar or other spinal region.

Verified May 8, 2026 · 7 sources ↓

Medicare: $319.65
Work RVU: 5.88
Global, days
Region: Spine

Drawn from CMSAAPCEmednyNIHAAOS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Operative note must identify each vertebral level addressed by number (e.g., L3, L4) — not just 'additional levels'
Explicitly document the anterior surgical approach used at each additional segment
Record that discectomy was performed at each additional segment billed under 22226
State the indication: spinal deformity diagnosis with description of preoperative alignment and correction achieved
Include intraoperative imaging or navigation records confirming levels treated if fluoroscopy was used
Document the total number of vertebral segments operated on to support primary code plus add-on unit count

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 62 Co-surgeons 80 Assistant surgeon AS PA/NP/CNS assistant

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 22226 is the add-on code for anterior approach spinal osteotomy with discectomy when the surgeon operates on more than one vertebral segment. The primary codes — 22220 (cervical), 22222 (thoracic), and 22224 (lumbar) — cover the first segment. Report 22226 once for each additional segment addressed through the same anterior approach during the same operative session. Because it carries a ZZZ global period, 22226 inherits the global period of the primary procedure it accompanies.

The procedure involves resecting a portion of the vertebral body and removing adjacent disc material via an anterior approach to correct spinal deformity or pathologic alignment. The anterior corridor allows direct access to the vertebral body and disc space, making it the preferred route when the deformity is primarily anterior. Orthopedic surgeons and neurosurgeons performing multi-level corrective spinal surgery are the dominant billers.

As an add-on code, 22226 is exempt from modifier 51. It must always be reported alongside a primary osteotomy code (22220, 22222, or 22224). Billing it as a standalone code will trigger an automatic denial. NCCI bundling rules govern what ancillary services can be separately reported on the same date; fluoroscopic guidance is not separately billable if already included in the primary procedure's descriptor per NCCI Chapter 4 guidance.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (5.88) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (9.57) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	5.88
Practice expense RVU	1.93
Malpractice RVU	1.76
Total RVU	9.57
Medicare national rate	$319.65
Global period	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	$319.65

Common denial reasons

The recurring reasons claims for CPT 22226 get rejected.

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

22226 billed without a companion primary osteotomy code (22220, 22222, or 22224) — standalone billing always denies
Number of add-on units billed exceeds the number of additional segments documented in the operative note
Modifier 51 incorrectly appended to 22226 — it is an add-on code and modifier 51 does not apply
Diagnosis code does not support multi-level osteotomy (single-level or non-deformity ICD-10 paired with multiple units)
Operative report lacks level-by-level documentation of discectomy, causing payer to deny the anterior approach descriptor
Fluoroscopy billed separately when bundled into the primary procedure under NCCI policy

Frequently asked questions

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

01Can 22226 be billed as a standalone code?

No. 22226 is an add-on code and must always be reported with a primary anterior osteotomy code: 22220 (cervical), 22222 (thoracic), or 22224 (lumbar). Billing it alone results in automatic denial.

02How many times can 22226 be reported on a single claim?

Once per additional vertebral segment treated. If the surgeon operates on three segments total via the anterior approach, bill the primary code once and 22226 twice. Each unit must be supported by level-specific documentation in the operative note.

03Should modifier 51 be added to 22226?

No. Add-on codes are exempt from modifier 51. Appending it incorrectly can trigger a payment reduction or edit that shouldn't apply.

04What global period applies to 22226?

22226 carries a ZZZ global period, meaning it has no independent global window. It inherits the global period of the primary procedure it accompanies — typically the 90-day global attached to the primary osteotomy code.

05Can two surgeons each bill 22226 using modifier 62 for co-surgery?

Yes. When two surgeons of different specialties (e.g., orthopedic spine and neurosurgery) perform the anterior osteotomy together, each may append modifier 62 to both the primary code and 22226, with each surgeon's operative report documenting their distinct contribution.

06Is fluoroscopy separately billable with 22226?

Generally no. Per NCCI Chapter 4 guidance, if radiologic guidance is integral to the procedure or included in the primary code's descriptor, it cannot be billed separately. Verify against the specific primary code's descriptor before reporting a separate fluoroscopy code.

07What ICD-10 diagnoses most commonly support 22226?

Multi-level spinal deformity diagnoses drive most claims — including kyphosis, scoliosis, and spondylolisthesis codes. Single-level diagnoses paired with multiple add-on units are a common audit flag. The diagnosis should reflect the scope of correction performed.

Sources & references

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

Mira Scribe

Mira's AI scribe captures the anterior approach, each vertebral level by name and number, confirmation that discectomy was performed at every additional segment, and the deformity indication driving multi-level correction. That level-by-level specificity is what prevents the most common denial — units billed exceeding levels documented — and satisfies NCCI scrutiny of add-on code utilization.

See how Mira captures CPT 22226 documentation