Closed treatment of a vertebral fracture without manipulation — no reduction performed, typically managed with bracing or casting.

Verified May 8, 2026 · 6 sources ↓

Medicare: $341.36
Total RVUs: 10.22
Global, days: 90
Region: Spine

Drawn from CMSBedrockbillingAAPC

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the vertebral level(s) affected (e.g., L1, T12) — 'thoracic spine' alone is insufficient for audit purposes
Confirm no manipulation or reduction was performed — document the treatment decision explicitly
Document the conservative treatment plan prescribed, including type of orthosis (e.g., TLSO) and rationale
Record neurologic status at the time of evaluation to support medical necessity
If an E/M is billed same-day with modifier 25, document the distinct clinical issue addressed beyond the fracture management decision
Imaging findings (X-ray, CT, or MRI) confirming fracture diagnosis and stability should be referenced in the note

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22310 covers closed treatment of a spinal vertebral fracture where no manipulation or reduction is performed. The treating physician manages the fracture conservatively — typically by prescribing and overseeing orthotics such as a TLSO brace — without any attempt to realign the fracture fragment. This code applies across cervical, thoracic, and lumbar levels as long as no manipulative reduction occurs.

The 90-day global period means all routine follow-up related to the fracture, including office visits, brace checks, and wound care, is bundled into the single procedure payment through day 90. Billing a separate E/M during that window requires modifier 24 (unrelated condition) or modifier 25 (significant, separately identifiable service on the date of the procedure itself). A common audit flag is billing an E/M on the same date as 22310 without modifier 25 and clear documentation of a distinct, separately identifiable service.

Radiologic guidance is not included in the code descriptor, so imaging used to assess the fracture may be separately reportable — but confirm NCCI bundling rules before doing so. The physician ordering and supervising the conservative management (including the brace) can bill 22310 even if a separate technician applies the orthotic, provided the supervising physician documents their role in fracture management.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.36
Practice expense RVU	6.07
Malpractice RVU	0.79
Total RVU	10.22
Medicare national rate	$341.36
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	$341.36
HOPD (APC 5111) Hospital outpatient department	$252.01
ASC (PI A2) Ambulatory surgical center (freestanding)	$135.54

Common denial reasons

The recurring reasons claims for CPT 22310 get rejected.

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

E/M billed on the same date without modifier 25, triggering bundling denial under NCCI minor surgical procedure rules
Fracture level or anatomic detail missing from documentation, causing medical necessity failure on audit
22310 billed during the 90-day global period of a prior spinal procedure without modifier 24 or 79 to establish a distinct, unrelated service
Manipulation or reduction documented in the note, which points to 22315 instead — mismatched code-to-note content triggers downcoding or denial
Missing documentation of physician involvement in fracture management when billing for brace oversight performed by ancillary staff

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Can I bill 22310 if my staff applies the TLSO brace rather than the physician?

Yes. The physician bills 22310 for directing the conservative management of the fracture — including prescribing the orthosis — not for physically applying it. Document the physician's role in the fracture management decision clearly in the note.

02What is the difference between 22310 and 22315?

22310 is for closed treatment without any manipulation or reduction. 22315 is for closed treatment with manipulation. If the operative or clinical note describes any attempt to reduce or reposition the fracture, 22315 is the correct code. Billing 22310 when manipulation is documented is a misuse that auditors flag.

03Can I bill an E/M on the same day as 22310?

Only with modifier 25, and only if you document a significant, separately identifiable evaluation and management service beyond the decision to perform the fracture management. The E/M and 22310 do not need different diagnoses, but the note must clearly support both services.

04What global period applies to 22310, and what does it cover?

22310 carries a 90-day global period. That covers the day of the procedure and all routine follow-up related to the fracture through day 90 — office visits, brace checks, and routine imaging reviews. Services for unrelated conditions require modifier 24.

05Does 22310 cover all spinal levels?

Yes. The code is not level-specific — it applies to cervical, thoracic, and lumbar vertebral fractures treated closed without manipulation. Document the specific level(s) in the note regardless; payers and auditors expect level specificity even when the code itself doesn't require it.

06Can 22310 be billed during the global period of a prior spinal fusion?

Only if the fracture is unrelated to the prior surgery. Use modifier 79 (unrelated procedure during global period) and document clearly that the fracture is at a distinct level or is a new, unrelated injury. Modifier 78 would apply if the fracture were a complication of the prior procedure requiring a return to care.

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 vertebral level, fracture characterization, neurologic status, explicit statement that no manipulation was performed, and the prescribed orthosis type from the physician's dictation. That detail prevents the two most common 22310 audit failures: an underdocumented fracture level and a missing 'no manipulation' statement that auditors use to challenge whether 22315 should have been billed instead.

See how Mira captures CPT 22310 documentation