Fusion · Spine

Kyphectomy with circumferential spinal exposure and full resection of three or more vertebral segments, including vertebral body and posterior elements.

Verified May 8, 2026 · 6 sources ↓

Medicare: $2,201.79
Total RVUs: 65.92
Global, days: 90
Region: Spine

Drawn from CMSNIHAAPCHighridgemedical

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit count of vertebral segments resected (minimum three) with spinal levels identified by name, e.g., T4, T5, T6
Confirmation that both vertebral body and posterior elements were resected at each segment — circumferential exposure must be documented
Underlying deformity diagnosis (e.g., kyphosis, spina bifida) with supporting imaging referenced in the operative note
Distinction from partial corpectomy — note must use kyphectomy terminology and describe complete segmental resection, not partial removal
Co-surgeon roles documented if modifier 62 is applied, with each surgeon's distinct intraoperative contribution described
Approach narrative sufficient to differentiate from posterior-only or anterior-only procedures

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 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22819 covers a kyphectomy in which the surgeon achieves circumferential exposure of the spine and resects three or more complete vertebral segments — body and posterior elements together. The code applies to severe spinal deformities such as kyphosis associated with spina bifida, where partial resection or posterior-only approaches are insufficient. The segment threshold is the line between 22818 (one or two segments) and 22819 (three or more); misidentifying the segment count is the most common coding error on these cases.

This is among the highest-complexity spine deformity codes, carrying a 90-day global period. All routine postoperative management through day 90 is bundled. Separately billable instrumentation codes (e.g., 22840-series) may be reported in addition, but vertebral body tethering codes 22836–22838 explicitly exclude 22819 from concurrent billing. Co-surgeon billing (modifier 62) is common given the circumferential exposure requirement.

Do not substitute 22819 for partial corpectomy procedures — those are distinct work and distinct codes. If the operative note describes corpectomy rather than kyphectomy, the claim will not support 22819 regardless of diagnosis.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	38.4
Practice expense RVU	19.34
Malpractice RVU	8.18
Total RVU	65.92
Medicare national rate	$2,201.79
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	$2,201.79
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 22819 get rejected.

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

Segment count not documented — payer downcodes to 22818 when the operative note does not explicitly state three or more segments were resected
Operative note describes partial corpectomy rather than kyphectomy, making 22819 unsupported on audit
Concurrent billing with vertebral body tethering codes 22836–22838, which bundle and exclude 22819
Missing or inadequate co-surgeon documentation when modifier 62 is submitted without each surgeon's distinct role described
Global period violations — post-op E/M visits billed without modifier 24 when unrelated to the surgical condition

Frequently asked questions

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

01What separates 22818 from 22819?

Segment count is the only differentiator. One or two completely resected segments bill as 22818. Three or more bill as 22819. Document the exact count and spinal levels in the operative note — do not rely on the diagnosis code to carry the distinction.

02Can 22819 be billed with instrumentation codes?

Yes. Instrumentation codes in the 22840-series (e.g., 22842, 22843) are separately reportable alongside 22819 when implants are placed. However, vertebral body tethering codes 22836–22838 explicitly bundle out 22819 and cannot be billed concurrently.

03Is modifier 62 (co-surgeon) appropriate for 22819?

Circumferential exposure often requires two surgeons working simultaneously — one managing the anterior column, one the posterior. Modifier 62 applies when both surgeons' distinct intraoperative roles are documented. Each surgeon bills 22819-62 with their own operative note describing their specific work.

04What is the global period for 22819, and what does it cover?

22819 carries a 90-day global period. All routine post-op visits, wound checks, and dressing changes through day 90 are bundled. Bill a new problem or unrelated visit with modifier 24. A staged procedure within the global period requires modifier 58.

05Can 22819 be billed if the surgeon performed a partial corpectomy instead of a kyphectomy?

No. Partial corpectomy is a distinct procedure. If the operative note describes partial removal of a vertebral body without full circumferential exposure and complete segmental resection, 22819 is unsupported. Use the corpectomy code family instead and document the work actually performed.

06Is modifier 22 defensible for an unusually complex 22819?

Yes, when the complexity materially exceeded typical — severe deformity, prior fusion hardware, or significant adhesions requiring substantially increased operative time. Attach a cover letter with operative time, estimated blood loss, and a narrative explaining the added work. Routine complexity does not support modifier 22.

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 exact number and spinal levels of vertebral segments resected, confirms circumferential exposure and complete removal of both body and posterior elements, and flags the underlying deformity diagnosis from dictation. This prevents the most common 22819 denial: a vague operative note that fails to document three or more fully resected segments, triggering a downcode to 22818 or an outright medical necessity denial.

See how Mira captures CPT 22819 documentation