Fusion · Spine

Kyphectomy involving circumferential spinal exposure and full resection of one or two vertebral segments, including both the vertebral body and posterior elements.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,911.87
Total RVUs: 57.24
Global, days: 90
Region: Spine

Drawn from AAPCNIHFindacodeGuidelinesCMS

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Explicitly state that both the vertebral body and posterior elements were resected — not just a partial corpectomy or osteotomy.
Identify the specific spinal level(s) and confirm the segment count (1 or 2) to support 22818 vs. 22819.
Document the underlying deformity diagnosis (e.g., congenital kyphosis, spina bifida) with corresponding ICD-10 code(s).
If modifier 62 is used, each co-surgeon must dictate a separate operative report explaining the medical necessity for two surgeons.
Record circumferential exposure technique — approach, patient positioning, and extent of decompression — to establish procedural completeness.
For modifier 22 (unusual procedural services), document specific intraoperative challenges such as severe deformity angle, prior surgical scarring, or neurological monitoring events.

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 66 Modifier 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 ↓

CPT 22818 covers a kyphectomy in which the surgeon circumferentially exposes the spine and completely resects one or two vertebral segments — body and posterior elements together. This is distinct from a partial corpectomy or osteotomy: the entire segment is removed, not just a portion. The procedure is performed for severe angular kyphotic deformities, classically in patients with spina bifida or congenital kyphosis where conservative and less aggressive surgical options have failed.

The 90-day global period bundles all routine post-operative management through day 90. Given the complexity and typical inpatient recovery, anything unrelated to the kyphectomy billed in that window requires modifier 24. When a co-surgeon from a different specialty (e.g., general or vascular surgery) is required for circumferential exposure, modifier 62 applies — both surgeons bill 22818 with modifier 62 and each must document the medical necessity for two surgeons in separate operative reports. Modifier 66 (team surgery) is theoretically eligible but requires individual payer negotiation for pricing.

For cases involving three or more segments, 22818 does not apply — use 22819. The distinction between a kyphectomy (full-segment resection) and a corpectomy (partial body removal) is a common audit trigger; the operative note must unambiguously describe complete resection of the vertebral body and posterior elements to support 22818.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	33.47
Practice expense RVU	16.63
Malpractice RVU	7.14
Total RVU	57.24
Medicare national rate	$1,911.87
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	$1,911.87
HOPD (APC 5116) Hospital outpatient department	$17,913.59
ASC (PI G2) Ambulatory surgical center (freestanding)	$9,255.83

Common denial reasons

The recurring reasons claims for CPT 22818 get rejected.

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

Operative note describes a partial corpectomy or vertebral body subtraction osteotomy rather than complete segment resection, making 22818 unsupportable.
Segment count discrepancy — note documents three or more levels resected but 22818 (1-2 segments) was billed instead of 22819.
Missing or insufficient documentation of medical necessity for the deformity severity warranting full kyphectomy rather than a less invasive osteotomy.
Co-surgeon claim denied because modifier 62 operative reports lack individualized documentation of each surgeon's distinct role and necessity.
Routine post-operative E/M visits billed without modifier 24 within the 90-day global period.

Frequently asked questions

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

01What is the difference between CPT 22818 and 22819?

22818 covers kyphectomy of one or two vertebral segments. 22819 applies when three or more segments are resected. If your count hits three, you must bill 22819 — 22818 has a hard segment ceiling of two.

02Can 22818 be billed for a partial corpectomy?

No. 22818 requires complete resection of the vertebral segment including both the body and posterior elements. A partial corpectomy does not meet that threshold and will not survive audit under 22818.

03How does the 90-day global period affect post-op billing for 22818?

The 90-day global bundles all routine post-op care from the day of surgery through day 90. E/M visits or procedures for conditions unrelated to the kyphectomy need modifier 24 (E/M) or 79 (unrelated procedure) to get paid.

04When is modifier 62 appropriate for 22818?

Use modifier 62 when two surgeons of different specialties each perform distinct, necessary portions of the kyphectomy — for example, a spine surgeon and a vascular surgeon sharing circumferential exposure. Both bill 22818-62, and each must submit a separate operative report documenting their individual role and medical necessity.

05Is modifier 66 (team surgery) an option for 22818?

Technically yes — CPT 22818 is among the complex vertebrectomy codes eligible for modifier 66. However, pricing under 66 is not standardized; it requires individual negotiation with each payer. Most practices default to modifier 62 when two surgeons are involved.

06What ICD-10 codes are typically paired with 22818?

Common diagnoses include congenital kyphosis (Q76.419), spina bifida with associated spinal deformity (Q05 series), and severe postural or structural kyphosis (M40 series). The diagnosis must reflect deformity severity sufficient to justify full segment resection.

07Can an assistant surgeon bill alongside 22818, and which modifier applies?

Yes. A physician assistant surgeon bills with modifier 80. An advanced practice provider assisting bills with modifier AS. Documentation must support the medical necessity for an assistant given the complexity of circumferential spinal exposure.

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 specific vertebral levels resected, confirms complete removal of both vertebral body and posterior elements, and records the approach used for circumferential exposure — all from the surgeon's dictation. This prevents the most common 22818 audit flag: an operative note that describes partial vertebral work (corpectomy or osteotomy language) when a full kyphectomy was actually performed. For co-surgeon cases, the scribe prompts each surgeon to document their distinct role, satisfying modifier 62 requirements before the claim is submitted.

See how Mira captures CPT 22818 documentation