Open posterior treatment and/or reduction of a single fractured or dislocated thoracic vertebral segment, performed through a posterior approach.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,503.37
Total RVUs: 45.01
Global, days: 90
Region: Spine

Drawn from CMSAAPCAAOS

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify the thoracic level(s) treated (e.g., T6, T8) — level-vague notes are an audit target
Confirm posterior approach by name in the operative report; 'standard approach' is insufficient
Document the nature of injury — fracture, dislocation, or fracture-dislocation — and mechanism
Record the number of fractured segments treated; single-level justifies 22327, each additional level requires 22328
Include pre-operative imaging (CT, MRI, or X-ray) confirming thoracic vertebral injury
If modifier 22 is appended, document specific factors increasing complexity (e.g., severe comminution, multilevel deformity, obesity, prior surgery at level)

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 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

22327 covers open posterior surgery to treat a fracture or dislocation of one thoracic vertebral segment. The surgeon makes a posterior incision, exposes the injured level, and reduces the fracture or dislocation under direct visualization. This is a single-level code; each additional fractured segment requires add-on code 22328.

22327 carries a 90-day global period. That window covers the day-before visit, the surgery itself, and all routine post-op care through day 90. E&M visits related to recovery are not separately billable unless modifier 24 applies for unrelated conditions. CMS assigns this code status indicator J1 under the 2026 OPPS, meaning it is restricted to the inpatient setting for Medicare — it will not pay in an HOPD or ASC context without meeting inpatient-only criteria.

Intraoperative neurophysiology monitoring (95940, 95941, G0453) is not separately billable by the operating surgeon — it is included in the global package. If a second, independent physician provides neuromonitoring, that physician can bill separately. Internal fixation hardware placed during the same session is reported with the appropriate instrumentation add-on codes and is not bundled into 22327 itself.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	20.25
Practice expense RVU	17.55
Malpractice RVU	7.21
Total RVU	45.01
Medicare national rate	$1,503.37
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	$1,503.37
HOPD (APC 5115) Hospital outpatient department	$13,116.76
ASC (PI J8) Ambulatory surgical center (freestanding)	$9,498.65

Common denial reasons

The recurring reasons claims for CPT 22327 get rejected.

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

Inpatient-only (J1) status — claim submitted on outpatient or ASC claim type denied automatically under OPPS
Missing or vague level documentation — payers reject claims that don't specify the thoracic vertebral level treated
Global period conflict — E&M or follow-up visit billed without modifier 24 within the 90-day post-op window
Unbundling error — neuromonitoring codes (95940, 95941) billed by the operating surgeon, which NCCI prohibits
Add-on code 22328 billed without primary code 22327 as the lead procedure on the claim

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Can 22327 be performed in an ASC or hospital outpatient setting for Medicare patients?

No. CMS assigns 22327 status indicator J1 under the 2026 OPPS, making it an inpatient-only procedure. Medicare will not reimburse 22327 on an outpatient or ASC claim. Non-Medicare payers vary — verify individual contracts.

02How do you bill for multiple fractured thoracic levels treated in the same session?

Use 22327 as the primary code for the first thoracic level. Append add-on code 22328 for each additional fractured vertebral segment treated in the same session. Do not report 22327 twice.

03Can the operating surgeon separately bill neuromonitoring during a 22327 procedure?

No. NCCI policy explicitly excludes intraoperative neurophysiology monitoring (95940, 95941, G0453) from separate billing by the operating surgeon — it is included in the global surgical package. A separate, independent monitoring physician can bill for those services.

04What modifier applies if this surgery is performed during the global period of a prior spine procedure?

Use modifier 79 if the thoracic fracture repair is unrelated to the prior procedure. Use modifier 78 if the return to the OR was unplanned and related to a complication of the original surgery. Do not invert these — 78 is for related, 79 is for unrelated.

05Is modifier 62 appropriate when two surgeons co-operate on 22327?

Yes, when two surgeons of different specialties each perform distinct portions of the procedure and both document their individual contributions, modifier 62 applies to both surgeons' claims. Each surgeon bills 22327-62. Documentation must support the medical necessity of co-surgery.

06When is modifier 22 justified for 22327?

Modifier 22 is appropriate when the procedure required substantially greater work than typical — for example, severe comminution, significant neurologic compromise requiring extended decompression, morbid obesity, or significant prior surgery at the same level. Document the specific factors in the operative report; payers routinely audit modifier 22 claims and will request records.

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 posterior approach, the specific thoracic vertebral level(s) treated, fracture or dislocation characterization, reduction technique, and the number of segments addressed — distinguishing single-level 22327 from multi-level cases requiring add-on 22328. This prevents the most common audit flag on thoracic fracture claims: operative notes that omit vertebral level or describe the approach generically.

See how Mira captures CPT 22327 documentation