Fusion · Spine

Anterior thoracic vertebral body tethering using screws and a flexible cord to correct scoliosis without fusion, covering up to 7 vertebral segments, with thoracoscopy included when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,809.33
Total RVUs: 54.17
Global, days: 90
Region: Spine

Drawn from AAPCCMSAAOS

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Explicit vertebral segment count (determines code selection between 22836 and 22837)
Skeletal maturity assessment — Risser grade or Sanders classification to support growth-modulation candidacy
Diagnosis of scoliosis with Cobb angle measurement documented in pre-op imaging and operative note
Operative note must confirm anterior thoracic approach and tether construct details (screw placement, cord tensioning)
Thoracoscopy use documented if performed — confirms it is bundled and not separately billable
Intended staging plan documented in the operative note if a future staged procedure is anticipated (supports modifier 58)

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 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 ↓

CPT 22836 covers anterior thoracic vertebral body tethering for up to 7 vertebral segments. The surgeon places screws into the anterior thoracic vertebrae and connects them with a flexible tether cord, compressing the convex side of the spinal curve to guide growth correction without arthrodesis. Thoracoscopy, when used to access the thoracic spine, is bundled into this code — bill it separately and expect a denial. This is a growth-modulation procedure, so patient skeletality (Risser grade, Sanders classification) is central to medical necessity documentation.

The 22836–22838 family was introduced in CPT 2024. Use 22836 for 1–7 vertebral segments, 22837 for 8 or more, and 22838 for revision, replacement, or removal of the tether. Segment count must be explicit in the operative note — the segment number is the code selector. If you're performing additional spinal instrumentation (e.g., posterior non-segmental instrumentation), those add-on codes in the 22840–22855 range may be reportable alongside 22836 per standard add-on rules.

The 90-day global period means all routine post-op management through day 90 is bundled. Any unrelated E/M during that window needs modifier 24. A planned staged return — such as tether augmentation — requires modifier 58 on the subsequent procedure and resets the global clock. An unplanned return to the OR for a complication related to the tether takes modifier 78.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	31.2
Practice expense RVU	16.33
Malpractice RVU	6.64
Total RVU	54.17
Medicare national rate	$1,809.33
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	$1,809.33
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 22836 get rejected.

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

Missing or ambiguous vertebral segment count — payer cannot confirm correct code (22836 vs. 22837) without explicit documentation
Thoracoscopy billed separately under a thoracic endoscopy code — it is bundled into 22836 when performed at the same session
Medical necessity not established — absent skeletal maturity data or Cobb angle measurements triggering non-covered-service denial
Unrelated E/M billed during the 90-day global period without modifier 24
Modifier 78 and 79 misapplication on return-to-OR claims — related complications require 78; unrelated procedures require 79

Frequently asked questions

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

01What is the difference between 22836 and 22837?

Segment count is the only differentiator. Use 22836 for up to 7 vertebral segments and 22837 for 8 or more. The operative note must state the segment count explicitly — 'multiple levels' is not sufficient.

02Is thoracoscopy separately billable when performed with 22836?

No. Thoracoscopy is bundled into 22836 when performed at the same operative session. Billing a separate thoracoscopy code will trigger an NCCI bundle denial.

03Can 22836 be reported with posterior instrumentation add-on codes?

Yes. Add-on codes in the 22840–22855 range for posterior non-segmental or segmental instrumentation may be reported alongside 22836 when that work is performed at the same session, subject to standard NCCI and payer-specific bundling edits.

04What modifier applies if the patient returns to the OR for tether augmentation within the 90-day global?

Use modifier 58 if the return was staged or planned and documented in the original operative note. Modifier 58 resets the global period. If the return was unplanned due to a complication related to the tether, use modifier 78 instead — that does not reset the global.

05What diagnosis codes support medical necessity for 22836?

Idiopathic scoliosis ICD-10 codes (M41.1x series by thoracic region) are the primary drivers. Payers expect documented Cobb angle severity and skeletal immaturity (e.g., Risser 0–2) to confirm the patient is a growth-modulation candidate rather than a fusion candidate.

06Does modifier 22 apply to unusually complex tethering cases?

Yes, but only when the operative work is substantially greater than typical — for example, severe curve magnitude, prior surgery creating an altered field, or significant anatomic anomalies. Document the specific circumstances and increased operative time in the note; vague language will not support the modifier.

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 vertebral segment count, surgical approach, tether construct details (screw levels, cord tensioning), thoracoscopy use, and skeletal maturity assessment directly from dictation. This prevents the most common 22836 audit flag: an operative note that omits the segment count, forcing a payer to downcode or deny when 22836 versus 22837 cannot be confirmed from the record.

See how Mira captures CPT 22836 documentation