Add-on code for open treatment of each additional vertebral fracture or dislocation beyond the first, reported alongside a primary spinal fracture repair code.

Verified May 8, 2026 · 6 sources ↓

Medicare: $252.51
Work RVU: 4.49
Global, days
Region: Spine

Drawn from CMSAAPCCodingclarifiedMedtronic

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify each fractured or dislocated vertebral level by name (e.g., T4, L2) in the operative note
Describe the fracture pattern at each level (compression, burst, flexion-distraction, fracture-dislocation)
Confirm that operative intervention — not just imaging review — was performed at each additional level
Document the surgical approach used to access each additional level (anterior, posterior, or combined)
Record the mechanism of injury or pathologic etiology supporting the need for multi-level repair
Specify any instrumentation placed at the additional level(s), coded separately

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 59 Distinct service 62 Co-surgeons 76 Repeat, same physician 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

22328 is an add-on code (ZZZ global) billed for each additional vertebral fracture or dislocation treated during the same operative session as a primary fracture repair (22325, 22326, or 22327). It is never reported alone — it requires a primary code. Each distinct fractured level treated surgically gets its own unit of 22328 beyond the first.

Vertebral fractures treated under this code typically result from high-energy trauma, pathologic compression, or burst-pattern injuries. The surgeon accesses the involved vertebra through a direct incision, performs open reduction and stabilization, and may incorporate instrumentation billed separately. Because multiple levels are common in polytrauma patients, accurate level-by-level documentation is critical — one undocumented level is one unit of 22328 left on the table.

ZZZ global means the add-on code follows the global of its primary code. Payer preauthorization requirements, medical necessity criteria for multi-level fracture repair, and documentation of each level's fracture pattern all factor into clean claim submission. Neurosurgery and spine surgery are the top-billing specialties for this code.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU vs. total RVU

The work RVU (4.49) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (7.56) adds practice overhead and malpractice, and is what drives the Medicare payment below.

Work RVU	4.49
Practice expense RVU	1.51
Malpractice RVU	1.56
Total RVU	7.56
Medicare national rate	$252.51
Global period	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	$252.51

Common denial reasons

The recurring reasons claims for CPT 22328 get rejected.

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

Billed without a primary fracture repair code (22325, 22326, or 22327) — 22328 cannot stand alone
Operative note does not document distinct surgical treatment at each additional level, only imaging findings
Units exceed the number of additional levels supported by operative documentation
Missing or insufficient medical necessity justification for multi-level open fracture repair
Prior authorization not obtained for complex multi-level spinal fracture surgery when required by payer

Frequently asked questions

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

01Can 22328 be billed without a primary fracture repair code?

No. 22328 is an add-on code and requires a primary spinal fracture repair code (22325, 22326, or 22327) on the same claim. Submitting it alone will result in an automatic denial.

02How many units of 22328 can be reported on a single claim?

One unit per each additional vertebral level treated surgically, beyond the first level covered by the primary code. Three fractured levels treated = one primary code plus two units of 22328. Units must be supported by level-specific documentation in the operative note.

03Does modifier 51 apply to 22328?

22328 is an add-on code, and CMS exempts add-on codes from modifier 51 reductions under standard payment rules. However, some commercial payers apply their own multiple-procedure logic — verify payer-specific policy before omitting modifier 51 on non-Medicare claims.

04What is the global period for 22328 and what does ZZZ mean practically?

ZZZ means the code carries no independent global period — it follows the global period of its parent primary code. Post-op care obligations for the multi-level repair session are governed by the primary fracture code billed alongside it.

05Should instrumentation placed at the additional levels be coded separately?

Yes. Spinal instrumentation codes (e.g., posterior segmental instrumentation, 22842–22844) are reported separately and are not bundled into 22328. Document each level of instrumentation distinctly in the operative note to support those additional codes.

06Can modifier 62 (two surgeons) be used with 22328?

Yes, when two surgeons each perform distinct portions of the multi-level fracture repair. Both surgeons append modifier 62 and each bills 22328 for their respective work. Operative notes from both surgeons must document the distinct roles.

07Is 22328 used for vertebroplasty or kyphoplasty at additional levels?

No. Vertebroplasty and kyphoplasty have their own CPT codes (22510–22515 series). The 22325–22328 family covers open surgical treatment of fractures and dislocations, not percutaneous augmentation procedures.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira Scribe

Mira's AI scribe captures the vertebral level designation, fracture morphology, and confirmation of direct surgical intervention at each additional level from the surgeon's dictation. This prevents the most common audit flag for 22328: operative notes that reference imaging findings at multiple levels but fail to document that the surgeon actually treated each one.

See how Mira captures CPT 22328 documentation