Fusion · Spine

Single-level posterior or posterolateral thoracic spine arthrodesis using a transverse process technique

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,255.54
Total RVUs: 37.59
Global, days: 90
Region: Spine

Drawn from CMSFastrvuMdclarityAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify the exact thoracic level(s) fused (e.g., T6-T7) — level ambiguity is a primary audit trigger
Document the surgical approach explicitly: posterior, posterolateral, or lateral transverse process technique
Describe decortication of transverse processes and posterior elements performed to prepare the fusion bed
Identify bone graft type and source (autograft, allograft, bone substitute) with harvest site if autograft
List all instrumentation placed separately; instrumentation must be documented to support companion instrumentation codes
Record pre-op diagnosis with supporting imaging findings (MRI, CT, or plain film) that justify the arthrodesis

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 76 Repeat, same physician 77 Repeat, another physician 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 ↓

22610 covers a one-level spinal fusion at the thoracic spine performed through a posterior or posterolateral approach, using the transverse process as the fusion target. The surgeon decorticates the transverse processes and posterior elements, then lays bone graft to achieve a solid arthrodesis across that single interspace. This is a standalone fusion code — instrumentation (pedicle screws, rods) and bone grafting are reported separately when performed.

The 90-day global period means all routine postoperative management through day 90 is bundled. Unrelated E/M visits in that window need modifier 24; a separately identifiable decision-making visit on the day of surgery needs modifier 57 if it's the surgery decision visit, or 25 if it's a separate E/M same-day.

Multi-level thoracic fusion requires add-on code 22614 for each additional interspace beyond the first. Confirm payer policy on instrumentation codes (22840–22848 range) because some commercial plans bundle instrumentation differently than Medicare does under NCCI.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	16.85
Practice expense RVU	14.96
Malpractice RVU	5.78
Total RVU	37.59
Medicare national rate	$1,255.54
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	$1,255.54
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,131.97

Common denial reasons

The recurring reasons claims for CPT 22610 get rejected.

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

Missing or ambiguous thoracic level documentation — payers require specific vertebral levels, not just 'thoracic spine'
Instrumentation codes denied as bundled when operative note doesn't clearly describe distinct instrumentation steps
Medical necessity denial when pre-authorization was not obtained or supporting imaging is absent from the record
Incorrect use of 22610 for a lumbar or cervical level — those require different base arthrodesis codes
Add-on code 22614 denied when the primary code 22610 was not also reported or was denied

Frequently asked questions

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

01What is the difference between 22610 and 22614?

22610 is the primary code for the first thoracic interspace fused via posterior or posterolateral technique. 22614 is an add-on code reported for each additional interspace at the same operative session. You cannot bill 22614 without 22610 as the base.

02Can 22610 and instrumentation codes be billed together?

Yes. Posterior instrumentation codes (e.g., 22840–22842) are not bundled into 22610 under NCCI and are separately reportable. The operative note must document the instrumentation steps distinctly from the fusion work.

03When is modifier 62 appropriate for 22610?

Use modifier 62 when two surgeons — typically a neurosurgeon and an orthopedic spine surgeon — each perform distinct, documented portions of the same single-level fusion. Both surgeons append modifier 62 to 22610, and each submits their own operative note describing their specific work.

04Does the 90-day global period affect billing for postoperative complications?

Routine post-op care through day 90 is bundled. If a complication requires a return to the OR for a related procedure, bill the return with modifier 78. If the return is for an unrelated condition, use modifier 79. Do not invert these — modifier 78 is related, 79 is unrelated.

05Is prior authorization required for 22610?

Most commercial payers and Medicare Advantage plans require prior authorization for elective thoracic arthrodesis. Medicare fee-for-service does not require prior auth, but does require medical necessity documentation. Verify payer-specific requirements before scheduling.

06Can 22610 be reported with a same-day E/M visit?

Only if the E/M represents a separately identifiable service beyond the pre-operative assessment. If the visit is the decision for surgery, append modifier 57. If it addresses a problem unrelated to the surgery, append modifier 25. Neither applies to routine pre-op clearance, which is bundled.

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 thoracic level treated, the posterior/posterolateral approach, decortication technique, graft type and source, and all instrumentation placed — automatically flagging the operative note if level documentation is missing or the approach is described generically. This prevents the most common audit trigger for 22610: level ambiguity that forces a post-payment review.

See how Mira captures CPT 22610 documentation