Fusion · Spine

Posterior spinal arthrodesis for deformity correction spanning 7 to 12 vertebral segments, with or without body cast application.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,936.25
Total RVUs: 57.97
Global, days: 90
Region: Spine

Drawn from CMSEvicoreAAOSSrs

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Exact vertebral segment count documented in the operative report — identify each level fused by name (e.g., T4–L2) to support the 7–12 segment threshold
Radiographic imaging (full-length standing AP and lateral) with Cobb angle measurement or other quantified deformity metrics documented pre-operatively
Diagnosis specificity in the operative note: name the deformity type (idiopathic scoliosis, degenerative kyphosis, neuromuscular scoliosis, etc.) and link to ICD-10
Instrumentation details: screw/rod/hook type and levels, plus any interbody device use, documented separately to support add-on code billing
Bone graft documentation: graft type (autograft, allograft, BMP), harvest site if applicable, and quantity — required for separately reportable graft codes
If modifier 62 (co-surgery) is used, each surgeon's operative note must describe their distinct intraoperative role and contribution
Conservative treatment history and duration documented in the pre-op workup to satisfy medical necessity requirements for payer review

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 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

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

22802 covers posterior spinal fusion performed to correct structural deformity — most commonly scoliosis or kyphosis — across 7 to 12 vertebral segments. The segment count drives code selection within the 22800 family: use 22800 for up to 6 segments, 22802 for 7–12, and 22804 for 13 or more. Miscounting segments is the most common upcoding or downcoding error auditors flag in this family.

This is a high-RVU, 90-day global procedure performed almost exclusively in the inpatient hospital setting. Instrumentation (pedicle screws, rods, hooks) is reported separately using the appropriate spinal instrumentation add-on codes. Bone grafting — autograft harvest, allograft application, or bone morphogenetic protein use — requires its own separately reportable codes and robust documentation. If a co-surgeon (modifier 62) or surgical assistant (modifier AS or 80) participates, operative notes must reflect each surgeon's distinct, documented contribution.

Payer prior authorization requirements for this code are nearly universal and criteria-driven. Cigna's CMM-614 policy, for example, requires documented failure of conservative management, radiographic confirmation of deformity magnitude, and clinical correlation before approving thoracic or thoracolumbar fusion. Pediatric deformity cases may trigger additional review criteria. Submit the full clinical record — not just the operative report — when appealing medical necessity denials.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	31.31
Practice expense RVU	17.86
Malpractice RVU	8.8
Total RVU	57.97
Medicare national rate	$1,936.25
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	$1,936.25
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI J8) Ambulatory surgical center (freestanding)	$13,933.19

Common denial reasons

The recurring reasons claims for CPT 22802 get rejected.

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

Incorrect segment count — operative note lists levels fused but biller selects wrong code tier (22800 vs. 22802 vs. 22804)
Medical necessity denial when pre-authorization criteria are not met or documentation submitted to payer is incomplete — Cigna CMM-614 and similar policies require failure of conservative care and objective deformity metrics
Unbundling errors when instrumentation or graft add-on codes are billed without the primary fusion code, or when decompression codes are appended without modifier 59 at a separate level per NCCI policy
Global period violations — post-op E/M visits billed without modifier 24 during the 90-day global, or staged return procedures billed without modifier 58 or 78 as appropriate
Missing or inadequate co-surgery documentation when modifier 62 is appended but operative notes do not individually describe each surgeon's distinct work

Frequently asked questions

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

01How do I choose between 22800, 22802, and 22804?

Count the fused vertebral segments: 22800 covers up to 6, 22802 covers 7–12, and 22804 covers 13 or more. The operative note must identify each level by name so auditors can verify the count independently.

02Can I bill instrumentation add-on codes separately with 22802?

Yes. Posterior segmental instrumentation add-on codes (e.g., 22842–22844 depending on segment count) are reported in addition to 22802. Document each instrumented level and hardware type in the operative note.

03Is modifier 62 appropriate when two surgeons perform this procedure together?

Yes, if both surgeons perform distinct portions of the procedure requiring their individual skills simultaneously. Both must document their specific intraoperative contributions in separate operative notes. Without that, payers will reduce or deny the co-surgery claim.

04What modifier applies if the patient returns to the OR for a related complication within the 90-day global?

Use modifier 78 for an unplanned return to the OR for a procedure related to the original surgery within the global period. Modifier 79 is for an unrelated procedure. Do not invert them — it is a common audit finding.

05Does 22802 require prior authorization?

Almost universally, yes. Most commercial payers — including those using eviCore/Cigna CMM-614 criteria — require documented deformity magnitude, failed conservative management, and clinical correlation before approving posterior spinal deformity fusion. Obtain auth before scheduling and attach the full clinical workup, not just the operative plan.

06Can an E/M visit be billed the day before this surgery?

Yes, if that visit is when the decision for surgery was made. Append modifier 57 to the E/M code. Without modifier 57, the pre-op visit is bundled into the 90-day global and will be denied.

07What ICD-10 codes are typically paired with 22802?

Common pairings include M41.xx (scoliosis codes, with specificity for type and region), M40.xx (kyphosis and lordosis), and Q67.5 (congenital deformity of spine) for pediatric cases. Deformity type and spinal region must match the operative documentation.

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 named vertebral levels fused, total segment count, deformity diagnosis, instrumentation details, graft type and source, and each surgeon's role from dictation — producing the level-specific operative documentation needed to defend the 22802 tier on audit and satisfy payer prior authorization review. Missing segment counts and vague approach descriptions are the top triggers for downcoding and medical necessity denials in this code family.

See how Mira captures CPT 22802 documentation