Open treatment of a cervical spine fracture and/or dislocation, performed at a single vertebral level in the neck.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,473.65
Total RVUs: 44.12
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 7 cited references ↓

Specify the exact cervical vertebral level(s) treated (e.g., C4–C5) — vague references to 'cervical spine' are insufficient for audit defense.
Document the nature of the pathology: fracture, dislocation, or fracture-dislocation, with imaging correlation (CT or MRI report referenced).
Describe the open surgical approach by name (anterior, posterior, or combined) and confirm direct exposure of the fracture site.
Document fracture reduction technique and any internal fixation or instrumentation placed — required to support add-on instrumentation codes billed with 22326.
Record neurological status pre- and post-operatively, including any deficit, to support medical necessity and ICD-10 diagnosis coding.
Operative note must distinguish number of levels treated; if additional levels were treated, documentation must support billing 22328 for each.

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 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 7 cited references ↓

CPT 22326 covers open surgical treatment of a fracture and/or dislocation at one cervical vertebral level. This is a major spinal trauma procedure — not a stabilization injection or percutaneous technique — and typically involves direct exposure, fracture reduction, and often internal fixation of the cervical spine. Neurosurgery and orthopedic spine surgeons are the primary billers.

The code carries a 90-day global period. That means all routine post-op visits, wound checks, and fracture-related management through day 90 are bundled into the surgical payment. If additional vertebral levels require open treatment in the same operative session, report 22328 for each additional level. Spinal instrumentation codes (22840–22848) are separately reportable and should be billed alongside 22326 when instrumentation is placed — this is one of the few contexts where CMS NCCI policy explicitly permits those add-on codes with this code family.

Site of service matters significantly here. HOPD and ASC facility payments differ substantially; see the Site of Service comparison table. Because cervical spine fracture surgery is high-acuity and frequently performed in the hospital inpatient setting, confirm whether the claim is professional (physician) or facility before applying fee schedule values.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	20.32
Practice expense RVU	16.37
Malpractice RVU	7.43
Total RVU	44.12
Medicare national rate	$1,473.65
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	$1,473.65
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI G2) Ambulatory surgical center (freestanding)	$6,804.43

Common denial reasons

The recurring reasons claims for CPT 22326 get rejected.

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

Missing or vague level documentation — payers deny when the operative note fails to specify which cervical vertebral level was treated.
Instrumentation codes (22840–22848) denied when the operative note doesn't explicitly confirm hardware placement separate from the fracture reduction.
Bundling denials when E&M services are billed same-day without modifier 57 to indicate the visit drove the decision for major surgery.
Incorrect site-of-service designation on professional claims — billing facility rates for office-based documentation or vice versa triggers payment adjustments.
ICD-10 mismatch — using a closed fracture diagnosis code for an open surgical treatment claim, or failing to code associated neurological deficits.

Frequently asked questions

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

01Can I bill 22326 and 22328 together if two cervical levels are treated?

Yes. 22326 covers the primary level; 22328 is the add-on code for each additional level treated in the same session. Bill one unit of 22328 per additional level. No modifier 51 is needed on 22328 — it's an add-on code.

02Are spinal instrumentation codes separately billable with 22326?

Yes. CMS NCCI policy explicitly permits codes 22840–22848 and 22851 to be reported with 22326 when instrumentation is placed. The operative note must document the specific hardware used.

03What modifier do I use for a pre-operative E&M visit on the day of surgery?

Use modifier 57 on the E&M when that visit resulted in the decision to perform this major surgery (90-day global). Modifier 25 applies to minor surgical procedures — not here.

04Does the 90-day global period cover management of the cervical fracture if it's still healing at day 60?

Yes, routine fracture management and all related post-op visits are bundled through day 90. If a complication requires a separate unplanned return to the OR for a related procedure, bill with modifier 78. An unrelated procedure in the global window gets modifier 79.

05Is modifier 22 supportable on 22326 for a highly comminuted or unstable fracture?

Yes, but documentation must do the heavy lifting. The operative note needs to describe specific factors that increased complexity — prolonged reduction, unusual anatomy, multilevel instability addressed at one level — and operative time well above the typical range. Without that, payers will deny the upcharge.

06How should I handle bilateral reporting for cervical fracture surgery at the ASC?

If the procedure is bilateral, ASC claims require two separate claim lines — one with modifier LT and one with modifier RT, each billed with one unit of service. This differs from the standard physician billing approach under Medicare.

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 cervical level by name (e.g., C5), the surgical approach (anterior vs. posterior), fracture reduction technique, and whether instrumentation was placed — the four elements auditors check first on a 22326 claim. That specificity prevents the two most common denials: vague level documentation and unsupported instrumentation add-on codes.

See how Mira captures CPT 22326 documentation