Fusion · Spine

Revision, replacement, or removal of a previously placed thoracic vertebral body tethering construct — screws and flexible cable — used to treat progressive scoliosis, with thoracoscopy included when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $1,684.07
Total RVUs: 50.42
Global, days: 90
Region: Spine

Drawn from AAPCHighridgemedicalNIHCMSBedrockbilling

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Specify whether the procedure was a revision (e.g., augmentation or tether division), replacement, or complete removal — the operative note must distinguish clearly among these.
Confirm apex of the scoliotic curve and vertebral levels involved; thoracic apex is required to support 22838 vs. a Category III code.
Document use of thoracoscopy if performed, including port placement and visualization details — it is bundled, but absence of documentation triggers audit flags.
If modifier 62 is appended, both surgeons must submit separate operative reports describing their distinct operative work and the clinical necessity for co-surgeons.
Record the original tethering construct details (number of segments, hardware type) and the reason revision, replacement, or removal was required.
Include preoperative imaging (e.g., standing scoliosis films, Cobb angle measurements) demonstrating the clinical basis for the return procedure.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 51 Multiple procedures 58 Staged or related 62 Co-surgeons 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 22838 covers returning to a prior thoracic vertebral body tethering (VBT) construct to revise it (e.g., augmenting or dividing the tether), swap out components, or take the hardware out entirely. Thoracoscopy, when used for access, is bundled into the code — do not bill a separate thoracoscopy charge. The code was introduced for the 2024 CPT code set alongside 22836 and 22837 to complete the VBT family of codes.

This code is specific to the thoracic spine. If the original VBT was placed for a lumbar or thoracolumbar curve (apex at or below T12-L1), the revision work maps to Category III codes, not 22838. Confirm the curve apex and original construct location before selecting the code. The 90-day global period means all routine post-op care through day 90 is bundled; use modifier 24 for unrelated E&M visits and modifier 78 if an unplanned related return to the OR is required within the global window.

Two-surgeon billing with modifier 62 is explicitly supported — the AMA CPT Manual names 22838 as appropriate for co-surgeon reporting when an orthopaedic spine surgeon and a general or thoracic surgeon each perform distinct portions of the procedure. Both surgeons must dictate separate operative reports documenting the necessity for co-surgeons. An assistant surgeon (modifier 80) is not separately payable for this code — the indicator is 0.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	35.1
Practice expense RVU	11.57
Malpractice RVU	3.75
Total RVU	50.42
Medicare national rate	$1,684.07
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	$1,684.07
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 22838 get rejected.

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

Curve apex not documented as thoracic — payers reroute lumbar/thoracolumbar revisions to Category III codes and deny 22838.
Thoracoscopy billed separately with a standalone scope code; it is included in 22838 and will be bundled/denied under NCCI.
Modifier 62 appended without a separate operative report from each surgeon, causing one claim to deny for insufficient documentation.
Procedure billed during the 90-day global of the original VBT placement without appropriate modifier (78 for related return, 58 for staged procedure), triggering global period denial.
Modifier 80 (assistant surgeon) billed — the assistant surgeon indicator for 22838 is 0, meaning Medicare does not separately reimburse an assistant at this code.

Frequently asked questions

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

01Can 22838 be used for revision of a lumbar or thoracolumbar VBT?

No. 22838 is limited to thoracic VBT revisions. Revision of a lumbar or thoracolumbar tethering construct — where the curve apex is at or below T12-L1 — falls under Category III codes. Confirm apex location before coding.

02Is thoracoscopy separately billable with 22838?

No. Thoracoscopy is included in 22838 when performed. Billing a separate thoracoscopy code on the same date triggers an NCCI bundle denial.

03How do two surgeons bill for a revision VBT — does modifier 62 apply?

Yes. The AMA CPT Manual explicitly names 22838 as a code where modifier 62 is appropriate when an orthopaedic spine surgeon and a general/thoracic surgeon each perform distinct portions of the procedure. Both append modifier 62, both use the same ICD-10 codes, and both submit separate operative reports.

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

Use modifier 78 for an unplanned return to the OR for a procedure related to the original surgery. If the return was planned and staged at the time of the initial procedure, use modifier 58 instead.

05Does Medicare pay a separate assistant surgeon fee for 22838?

No. The Medicare assistant surgeon indicator for 22838 is 0, meaning payment for a separate assistant surgeon is not allowed under Medicare. Modifier 80 claims will deny. Verify with commercial payers individually.

06When was CPT 22838 introduced, and what did it replace?

22838 was added for the 2024 CPT code set alongside 22836 and 22837. Before these codes existed, VBT revision work had no dedicated Category I code; the addition created a complete family specifically for thoracic VBT procedures.

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 curve apex level, specific vertebral segments addressed, type of revision performed (augmentation, tether division, hardware replacement, or full removal), thoracoscopy use, and co-surgeon roles from dictation. That structured capture prevents the two most common denials: wrong spinal region (thoracic vs. lumbar) and missing co-surgeon documentation when modifier 62 is billed.

See how Mira captures CPT 22838 documentation