Fusion · Spine

Anterior thoracic vertebral body tethering via screw-and-cord construct placed across 8 or more vertebral segments, thoracoscopy included when performed.

Verified May 8, 2026 · 8 sources ↓

Medicare: $1,662.03
Total RVUs: 49.76
Global, days: 90
Region: Spine

Drawn from CMSAAPCHighridgemedicalNIHMedmutual

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Exact vertebral segment count and identification of levels tethered (determines 22836 vs. 22837)
Skeletal immaturity confirmed — Risser grade or bone age on imaging
Major Cobb angle measurement documented on standing radiograph, within 30–65 degree range
Prior bracing history: duration, compliance, failure, or documented intolerance
Operative note must name the approach and confirm thoracoscopy use if performed
If billing modifier 62, each co-surgeon must dictate a separate operative report describing their distinct intraoperative work
Payer prior authorization documentation, as most commercial payers require pre-approval for VBT

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 62 Co-surgeons 74 Discontinued post-anesthesia 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

22837 covers anterior thoracic vertebral body tethering (VBT) spanning 8 or more vertebral segments. The procedure places screws along the convex side of a scoliotic curve and threads a flexible polyethylene cord through them; tensioning the cord harnesses the patient's residual spinal growth to gradually correct the curve without fusion. Thoracoscopy, when used, is bundled — do not bill it separately. Use 22836 when the construct covers 7 or fewer segments.

VBT is indicated for skeletally immature patients with progressive adolescent idiopathic scoliosis, a major Cobb angle of 30–65 degrees, adequate bone for screw fixation, and documented bracing failure or intolerance. Most payers — including Medical Mutual — require all of those criteria to be met before approving the claim. Patients who are skeletally mature or outside the Cobb angle window will face denial on medical necessity grounds.

Modifier 62 is explicitly supported for 22836, 22837, and 22838. VBT is the most common pediatric orthopaedic case where co-surgeon billing with modifier 62 is clearly appropriate: the thoracic spine surgeon and the general/thoracic surgeon each report 22837-62 with separate operative notes documenting distinct work. The assistant surgeon indicator for these codes is 0 — assistant surgeon billing is not supported.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	34.61
Practice expense RVU	11.46
Malpractice RVU	3.69
Total RVU	49.76
Medicare national rate	$1,662.03
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	$1,662.03
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 22837 get rejected.

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

Medical necessity denial when skeletal maturity, Cobb angle, or bracing failure criteria are not explicitly documented
Segment count not documented, preventing distinction between 22836 and 22837
Thoracoscopy billed separately when it is already bundled into 22837
Modifier 62 missing when two surgeons each performed distinct operative roles during the same VBT procedure
Prior authorization absent or expired at time of service for commercial payers requiring it for VBT

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01What is the segment threshold that separates 22836 from 22837?

22836 covers up to 7 vertebral segments. 22837 applies when 8 or more segments are tethered. Count and document each level explicitly in the operative note — vague language triggers audits and wrong-code denials.

02Is thoracoscopy separately billable with 22837?

No. The descriptor includes thoracoscopy when performed. Billing a separate thoracoscopy code alongside 22837 will be bundled by NCCI edits.

03When is modifier 62 appropriate for 22837?

When a spine surgeon and a general or thoracic surgeon each perform distinct portions of the VBT procedure as co-primary surgeons, both bill 22837-62. Each must file a separate operative note describing their individual work. The AMA CPT Manual explicitly names 22836, 22837, and 22838 as appropriate for modifier 62.

04Can an assistant surgeon bill with 22837?

No. The assistant surgeon indicator for 22837 is 0, meaning assistant surgeon billing is not supported. Do not append modifier 80 or AS to this code.

05What medical necessity criteria do commercial payers require for 22837?

Most commercial payers — and Medical Mutual's published policy is a documented example — require: skeletal immaturity, major Cobb angle 30–65 degrees, osseous structure adequate for screw fixation, and documented failure of or intolerance to bracing. Missing any one criterion in the chart typically triggers a medical necessity denial.

06What ICD-10 diagnosis codes align with 22837?

Progressive adolescent idiopathic scoliosis codes (M41.1x series by thoracic level) are the primary matches. The specific level designation within the M41.1x range should correspond to the apex of the curve treated.

07What is the global period for 22837 and what does it cover?

22837 carries a 90-day global period. That includes the day-before visit, the surgery itself, and all routine post-op care through day 90. Unrelated E/M services in that window require modifier 24; a separate procedure for an unrelated condition requires modifier 79.

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 of tethered vertebral segments, the levels instrumented, thoracoscopy use, and confirmation of skeletal immaturity and Cobb angle from the operative dictation. It also flags whether two surgeons were present so modifier 62 is applied before the claim drops. This prevents the two most common 22837 denials: wrong code selection due to ambiguous segment count and missing co-surgeon modifier.

See how Mira captures CPT 22837 documentation