Open posterior reduction and stabilization of a lumbar vertebral fracture or dislocation, performed through a posterior surgical approach.

Verified May 8, 2026 · 7 sources ↓

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

Drawn from CMSAAPCSwiftmdsIsass

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Specify the exact vertebral level(s) treated (e.g., L2, L3-L4) — 'lumbar spine' alone is insufficient
State the surgical approach explicitly as posterior; operative notes that say 'standard approach' invite audit flags
Document the mechanism and severity of the fracture or dislocation, including preoperative imaging findings referenced by report date
Describe reduction technique and any stabilization hardware or instrumentation applied intraoperatively
Record intraoperative fluoroscopy use and confirm it is not separately billed — it is bundled into 22325
If modifier 22 is used, include a specific narrative explaining what increased the procedural work beyond typical (e.g., severe comminution, difficult anatomy, obesity)

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 57 Decision for surgery 58 Staged or related 59 Distinct service 62 Co-surgeons 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 7 cited references ↓

CPT 22325 describes open treatment of a lumbar spine fracture or dislocation via a posterior approach. The surgeon makes a posterior incision, directly visualizes the fractured or displaced vertebral segment, and performs reduction and stabilization. This is a distinct code from percutaneous or minimally invasive spinal fracture codes and from thoracic-level open fracture codes — approach and spinal region drive code selection.

The 90-day global period covers the surgery date, the day-before preoperative visit, and all routine postoperative care through day 90. Complications managed in the same operative session that substantially increase the work should be supported with modifier 22 and a documented addendum explaining the additional effort. Separate staged procedures in the global window require modifier 58; unrelated procedures need modifier 79.

Neurosurgery and orthopedic surgery account for the overwhelming majority of 22325 claims per CMS Physician Fee Schedule 2026 data. Claims billed from an HOPD versus ASC setting carry meaningfully different facility payment rates — confirm your site-of-service designator before submitting. Fluoroscopy used intraoperatively is bundled into the procedure and cannot be separately reported.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	19.37
Practice expense RVU	17.07
Malpractice RVU	6.8
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 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,305.25

Common denial reasons

The recurring reasons claims for CPT 22325 get rejected.

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

Missing or vague level documentation — payers require explicit vertebral level identification to adjudicate medical necessity
Incorrect site-of-service code causing mismatch between billed facility type and actual place of service
Fluoroscopy billed separately when it is integral to the open posterior spinal procedure
Global period violations — routine post-op visits billed without modifier 24 or 25 within the 90-day window
Modifier 22 submitted without a supporting operative note narrative explaining the nature and degree of increased complexity

Frequently asked questions

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

01Does 22325 cover thoracic fractures as well as lumbar?

No. CPT 22325 is specific to lumbar vertebral fractures and dislocations treated via open posterior approach. Thoracic-level open posterior fracture treatment maps to a different code. Confirm the operative level before selecting 22325.

02Can I separately bill fluoroscopy used during the 22325 procedure?

No. Intraoperative fluoroscopy is bundled into the open posterior fracture code per NCCI policy. Billing it separately will result in a denial of the imaging code.

03How does modifier 22 apply here, and what documentation does it require?

Use modifier 22 when the procedure required substantially more work than typical — severe comminution, morbid obesity, or complex anatomy are common justifications. The operative note must include a specific narrative explaining the added work, not just a checkbox. Without that narrative, most payers will strip the modifier and pay at the base rate.

04If I perform spinal instrumentation at the same session, how do I code that?

Spinal instrumentation codes (e.g., pedicle screw instrumentation add-ons) may be reported in addition to 22325 when performed at the same session. Apply modifier 51 as appropriate for multiple procedures, and verify that the NCCI PTP edits for your specific code combination allow separate billing.

05What global period applies to 22325, and how does that affect post-op billing?

22325 carries a 90-day global period. All routine post-op visits, dressing changes, and stitch removals within that window are included in the surgery payment. Bill unrelated E/M services with modifier 24; bill related E/M services that are a significant, separately identifiable service with modifier 25 only if they precede a procedure on the same day.

06When would modifier 58 apply for a patient who had 22325?

Use modifier 58 if a planned, staged, or therapeutic procedure related to the original fracture treatment is performed during the 90-day global period — for example, a subsequent planned instrumentation or fusion at the same level. Modifier 58 reopens a new global period; modifier 78 applies to unplanned returns to the OR for a related complication.

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, posterior approach confirmation, reduction technique, and any instrumentation placed from the surgeon's dictation — the details payers require to adjudicate 22325 on first pass. That prevents the most common denial trigger for spinal fracture claims: an operative note that names the procedure without specifying level and approach.

See how Mira captures CPT 22325 documentation