Open reduction of an odontoid fracture or dislocation via anterior cervical approach, with internal fixation and bone grafting.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,809.66
Total RVUs: 54.18
Global, days: 90
Region: Spine

Drawn from CMSAAPCFindacodeCgsmedicare

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Fracture classification (Type I, II, or III odontoid) and degree of displacement or subluxation documented in the operative or preoperative note
Explicit description of the anterior approach — not just 'standard anterior cervical approach'
Documentation that internal fixation was placed, specifying hardware type (e.g., cannulated screw)
Bone graft source and type recorded — autograft, allograft, or bone substitute — distinguishing 22319 from 22318
Preoperative neurological status and any deficits documented to support medical necessity
If co-surgeons billed under modifier 62, each surgeon's operative note must describe their distinct intraoperative role

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 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 6 cited references ↓

CPT 22319 covers open treatment of an odontoid fracture or dislocation — including os odontoideum — through an anterior neck incision, with placement of internal fixation and bone grafting. It is the graft-inclusive counterpart to 22318, which covers the same approach without grafting. If your operative note documents an anterior approach, internal fixation, and a bone graft, 22319 is the correct code; do not report 22318 plus a separate graft add-on.

Odontoid fractures are the most common cervical spine fractures and typically result from axial or flexion-extension trauma. Because this procedure addresses the C1-C2 articulation — the most mechanically critical segment of the cervical spine — documentation of the fracture classification (Type I, II, or III), the degree of displacement or subluxation, and the neurovascular status preoperatively is essential for supporting medical necessity and for accurate ICD-10 mapping.

The 90-day global period applies. That covers the day-before visit, the procedure, and all routine postoperative management through day 90. Any E/M for an unrelated condition during that window requires modifier 24. A significant, separately identifiable E/M on the day of surgery for a problem unrelated to the decision to operate requires modifier 25. Co-surgeon billing (modifier 62) is common given the complexity and proximity to the brainstem and vertebral arteries; both surgeons must document their distinct roles.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	24.7
Practice expense RVU	19.05
Malpractice RVU	10.43
Total RVU	54.18
Medicare national rate	$1,809.66
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	$1,809.66
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,493.97

Common denial reasons

The recurring reasons claims for CPT 22319 get rejected.

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

22318 billed when grafting was performed — use 22319 when the operative note documents bone graft placement
Separate graft add-on code reported alongside 22319 when graft is already included in the base code descriptor
Missing or vague fracture classification in the medical record, triggering medical necessity denial
Co-surgeon claims denied because both operative notes are identical rather than describing each surgeon's distinct role
E/M service billed same-day without modifier 25, triggering bundling denial under the global surgical package rules

Frequently asked questions

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

01What is the difference between 22318 and 22319?

Both codes describe open anterior odontoid fracture treatment with internal fixation. 22318 is reported when no bone graft is used; 22319 is reported when grafting is performed. Do not report 22318 plus a separate graft add-on code — if a graft was placed, 22319 is the correct single code.

02Can I separately bill a bone graft add-on code with 22319?

No. Grafting is included in the 22319 descriptor. Reporting a separate graft add-on alongside 22319 will generate an NCCI bundling denial. The graft work is already priced into the base code.

03When is modifier 62 appropriate for 22319?

Use modifier 62 when two surgeons of different specialties (typically neurosurgery and orthopedic spine surgery) each perform distinct portions of the procedure and each surgeon's role is separately documented in their own operative note. Both notes must describe different, non-duplicative intraoperative work.

04Does fluoroscopy used intraoperatively need to be billed separately?

No. Per NCCI policy, radiologic guidance integral to the surgical procedure — including intraoperative fluoroscopy used for screw placement — is not separately reportable. Do not add a fluoroscopy code to 22319 claims.

05What ICD-10 codes are typically paired with 22319?

Type II odontoid fractures (S12.1xx series) are the most common indication and the most likely to require open fixation. Os odontoideum (Q76.1) and fracture-dislocations at C1-C2 are also appropriate. Document laterality and displacement status in the fracture code to avoid ICD-CPT mismatch denials.

06Can 22319 be billed in an ASC setting?

Yes, it carries an ASC payment rate under CMS. However, given the proximity to the brainstem and vertebral arteries and the complexity of the reduction and fixation, the majority of these cases are performed in an inpatient hospital setting. Verify payer policy before scheduling in an ASC.

07What applies during the 90-day global period for 22319?

The 90-day global covers the day-before visit, the surgery, and all routine postoperative care through day 90. Bill modifier 24 for unrelated E/M visits during that window, modifier 79 for an unrelated procedure, and modifier 78 for an unplanned return to the OR for a complication related to the original surgery.

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 anterior approach, fracture classification, fixation hardware, and graft source directly from dictation — including whether the graft was autograft or allograft. That detail is what separates 22319 from 22318 at audit; a note that says 'bone graft was used' without specifying source or type is the most common flag that triggers a downcoding review or a request for additional records.

See how Mira captures CPT 22319 documentation