FeeBase
Log inGet started
Menu

CPT code 22208: Spinal osteotomy, additional three-column segment2026 Medicare rate & RVUs

Reports an additional vertebral segment treated with a three-column spinal osteotomy during posterior or posterolateral surgery for rigid spinal deformity.

CMS RVU26DEffective Oct 1, 2026109 payment localities219 Medicare services in 2024

Medicare pays $528.07 for 22208 nationally in a facility.

Medicare rate · 22208

Spinal osteotomy, additional three-column segment

Office or facility?

Work RVUs
9.42
Total RVUs
15.81
Global days
ZZZ

National rate · 2026

$528.07

Facility setting, before claim adjustments.

See every locality for 22208 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 22208 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 22208 covers

A three-column osteotomy removes bone through the front, middle, and back columns of the spine to help correct a rigid deformity, such as fixed kyphosis or scoliosis. Spine surgeons typically perform the procedure through a posterior or posterolateral approach during complex reconstructive surgery. Code 22208 represents an additional vertebral segment treated with this osteotomy, beyond the segment represented by the primary procedure.

Report 22208 only with an appropriate primary three-column osteotomy code, such as 22206 for a thoracic segment or 22207 for a lumbar segment. The operative report should identify the spinal levels treated and document the additional osteotomy work; the number of fusion levels alone does not establish the number of osteotomy segments. CMS classifies 22208 as an add-on code, so it is billed with a primary procedure and paid within that procedure’s global period.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 22208 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

22208 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$468.36
AlaskaUnavailable$644.32
ArizonaUnavailable$509.37
ArkansasUnavailable$461.21
Atlanta, GAUnavailable$552.20
Austin, TXUnavailable$522.69
Bakersfield, CAUnavailable$502.48
Baltimore area, MDUnavailable$566.21
Beaumont, TXUnavailable$510.89
Brazoria, TXUnavailable$506.11

22208 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
22208 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 22208 rate is calculated

Each of 22208’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 22208

RVUs × geographic indexes × conversion factor

Office or facility?

Work9.42

9.42 RVUs× 1.000 GPCI

Practice expense3.19

3.19 RVUs× 1.000 GPCI

Malpractice3.20

3.20 RVUs× 1.000 GPCI

Adjusted RVUs

15.8100

Conversion factor

$33.4009

Medicare rate

$528.07

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 22208

The CMS indicators that decide how 22208 is paid alongside other services.

CMS payment indicators · 22208

Spinal osteotomy, additional three-column segment

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)2Paid.
Co-surgeons (62)1Permitted with supporting documentation.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 80 · payment effect

With and without the modifier

22208 without 80 · national facility

$528.07

Spinal osteotomy, additional three-column segment

22208-80 · Assistant: 16%

$84.49

A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.

When to use modifier 80

22208 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 22208

    Spinal osteotomy, additional three-column segment9.42 wRVU

    Not priced

  • 22206

    Spinal osteotomy, thoracic, one segment36.25 wRVU

    Not priced

  • 22207

    Spinal osteotomy, lumbar, three-column, one segment35.76 wRVU

    Not priced

  • 22216

    Spinal osteotomy, each additional segment5.88 wRVU

    Not priced

  • 22214

    Spine osteotomy, one lumbar segment20.49 wRVU

    Not priced

How to choose

22206Spinal osteotomyThoracic, one segment
22206 reports the primary thoracic three-column osteotomy segment. Use 22208 for each additional segment treated with that technique.
22207Spinal osteotomyLumbar, three-column, one segment
22207 reports the primary lumbar three-column osteotomy segment. 22208 represents an additional segment, not the primary lumbar work.
22216Spinal osteotomyEach additional segment
22216 is an additional-segment code for another posterior or posterolateral osteotomy family; 22208 is specific to additional three-column osteotomy work.
22214Spine osteotomyOne lumbar segment
22214 represents a single lumbar segment in the posterior or posterolateral osteotomy family. 22208 is for an additional segment treated with a three-column osteotomy.

Codes related to 22208

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 22208
CodeHow it relatesNational office range
Add-on codes
22206Spinal osteotomy, thoracic, one segmentPrimary thoracic three-column osteotomy code that may be paired with this additional-segment code.No office rate
22207Spinal osteotomy, lumbar, three-column, one segmentPrimary lumbar three-column osteotomy code that may be paired with this additional-segment code.No office rate
Used instead
22216Spinal osteotomy, each additional segmentAdditional-segment code for a different posterior or posterolateral osteotomy family.No office rate
22214Spine osteotomy, one lumbar segmentLumbar posterior or posterolateral osteotomy for a single segment, rather than an additional three-column segment.No office rate

22208 billing questions

Can 22208 be billed by itself?

No. It is an add-on code and must be reported with an eligible primary three-column osteotomy, such as 22206 or 22207.

How is 22208 different from 22207?

22207 represents the primary three-column osteotomy at a lumbar segment. Use 22208 for an additional segment treated with the three-column technique.

Does the number of fused levels determine the units?

No. Document the vertebral segments where the additional three-column osteotomy was performed; fusion levels alone do not establish osteotomy units.

What documentation supports reporting 22208?

The operative report should identify the additional vertebral level and describe the three-column osteotomy performed there, along with the approach and primary procedure.

How does 22208 differ from 22216?

Both represent additional osteotomy segments, but 22208 belongs to the three-column osteotomy family. Code 22216 is used with a different posterior or posterolateral osteotomy family.

How does CMS treat payment for this add-on code?

CMS identifies 22208 as payable only with a primary procedure and within that procedure’s global period.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 22208PPRRVU2026_Oct_nonQPP.csv, line 2,053 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 22208 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 22208 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist