CPT code 22208: Spinal osteotomy, additional three-column segment2026 Medicare rate & RVUs in Arkansas
Reports an additional vertebral segment treated with a three-column spinal osteotomy during posterior or posterolateral surgery for rigid spinal deformity.
In Arkansas, Medicare pays $461.21 for 22208 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 22208 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How Arkansas compares for 22208
Across 109 of 109 payment localities, the facility rate for 22208 runs from $449.63 in Wisconsin to $695.86 in Miami, FL. Arkansas pays $461.21. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Arkansas · this page$461.21
- Los Angeles, CA · California$524.55+$63.34
- Washington, DC area · District of Columbia$576.10+$114.89
- Miami, FL · Florida$695.86+$234.65
- Chicago, IL · Illinois$669.22+$208.01
- Manhattan, NY · New York$628.10+$166.89
- Alaska · Alaska$644.32+$183.11
Other areas in Arkansas first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $468.36 |
| ArizonaArizona | — | $509.37 |
| Bakersfield, CACalifornia | — | $502.48 |
| Chico, CACalifornia | — | $494.05 |
| El Centro, CACalifornia | — | $494.59 |
| Fresno, CACalifornia | — | $494.05 |
| Hanford, CACalifornia | — | $494.05 |
| Madera, CACalifornia | — | $494.05 |
| Merced, CACalifornia | — | $494.05 |
| Modesto, CACalifornia | — | $494.05 |
| Napa, CACalifornia | — | $529.19 |
| Oxnard, CACalifornia | — | $515.98 |
| Redding, CACalifornia | — | $494.05 |
| Rest of CaliforniaCalifornia | — | $494.05 |
| Riverside, CACalifornia | — | $528.25 |
| Sacramento, CACalifornia | — | $507.17 |
| Salinas, CACalifornia | — | $505.17 |
| San Diego, CACalifornia | — | $509.44 |
| Marin County, CACalifornia | — | $543.82 |
| San Francisco, CACalifornia | — | $540.19 |
| San Benito County, CACalifornia | — | $560.18 |
| Santa Clara County, CACalifornia | — | $545.32 |
| San Luis Obispo, CACalifornia | — | $498.63 |
| Santa Cruz, CACalifornia | — | $507.99 |
| Santa Maria, CACalifornia | — | $504.97 |
| Santa Rosa, CACalifornia | — | $512.21 |
| Stockton, CACalifornia | — | $494.05 |
| Vallejo, CACalifornia | — | $523.95 |
| Visalia, CACalifornia | — | $494.05 |
| Yuba City, CACalifornia | — | $494.05 |
| ColoradoColorado | — | $515.26 |
| ConnecticutConnecticut | — | $565.01 |
| DelawareDelaware | — | $517.57 |
| Fort Lauderdale, FLFlorida | — | $615.81 |
| Rest of FloridaFlorida | — | $577.14 |
| Atlanta, GAGeorgia | — | $552.20 |
| Rest of GeorgiaGeorgia | — | $537.08 |
| Hawaii, Guam, HIHawaii | — | $497.67 |
| IowaIowa | — | $454.56 |
| IdahoIdaho | — | $463.22 |
| East St. Louis, ILIllinois | — | $627.92 |
| Rest of IllinoisIllinois | — | $578.97 |
| Suburban Chicago, ILIllinois | — | $615.66 |
| IndianaIndiana | — | $465.35 |
| KansasKansas | — | $464.83 |
| KentuckyKentucky | — | $507.16 |
| New Orleans, LALouisiana | — | $536.32 |
| Rest of LouisianaLouisiana | — | $511.33 |
| Metropolitan Boston, MAMassachusetts | — | $549.88 |
| Rest of MassachusettsMassachusetts | — | $517.05 |
| Baltimore area, MDMaryland | — | $566.21 |
| Rest of MarylandMaryland | — | $523.73 |
| Rest of MaineMaine | — | $479.14 |
| Southern Maine, MEMaine | — | $487.67 |
| Detroit, MIMichigan | — | $597.66 |
| Rest of MichiganMichigan | — | $532.59 |
| MinnesotaMinnesota | — | $455.91 |
| Metropolitan Kansas City, MOMissouri | — | $519.11 |
| Metropolitan St. Louis, MOMissouri | — | $523.17 |
| Rest of MissouriMissouri | — | $510.59 |
| MississippiMississippi | — | $485.36 |
| MontanaMontana | — | $527.85 |
| North CarolinaNorth Carolina | — | $482.34 |
| North DakotaNorth Dakota | — | $464.58 |
| NebraskaNebraska | — | $453.38 |
| New HampshireNew Hampshire | — | $519.08 |
| Northern New JerseyNew Jersey | — | $572.21 |
| Rest of New JerseyNew Jersey | — | $560.82 |
| New MexicoNew Mexico | — | $540.71 |
| NevadaNevada | — | $510.33 |
| NYC suburbs and Long Island, NYNew York | — | $659.94 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $574.79 |
| Queens, NYNew York | — | $614.84 |
| Rest of New YorkNew York | — | $491.00 |
| OhioOhio | — | $519.65 |
| OklahomaOklahoma | — | $492.83 |
| Portland, OROregon | — | $517.57 |
| Rest of OregonOregon | — | $495.90 |
| Metropolitan Philadelphia, PAPennsylvania | — | $558.73 |
| Rest of PennsylvaniaPennsylvania | — | $513.45 |
| Puerto RicoPuerto Rico | — | $527.64 |
| Rhode IslandRhode Island | — | $526.02 |
| South CarolinaSouth Carolina | — | $503.94 |
| South DakotaSouth Dakota | — | $457.10 |
| TennesseeTennessee | — | $468.89 |
| Austin, TXTexas | — | $522.69 |
| Beaumont, TXTexas | — | $510.89 |
| Brazoria, TXTexas | — | $506.11 |
| Dallas, TXTexas | — | $515.30 |
| Fort Worth, TXTexas | — | $515.62 |
| Galveston, TXTexas | — | $511.46 |
| Houston, TXTexas | — | $570.03 |
| Rest of TexasTexas | — | $512.27 |
| UtahUtah | — | $510.77 |
| VirginiaVirginia | — | $494.83 |
| Virgin Islands, VIUnited States Virgin Islands | — | $527.64 |
| VermontVermont | — | $474.20 |
| Rest of WashingtonWashington | — | $512.26 |
| King County, WAWashington | — | $548.43 |
| WisconsinWisconsin | — | $449.63 |
| West VirginiaWest Virginia | — | $560.18 |
| WyomingWyoming | — | $500.28 |
22208 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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
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.
The exact Arkansas inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
2,053
- Code
- 22208
- Physician work
- 9.42
- Practice expense
- 3.19
- Malpractice
- 3.20
GPCI2026.csv
7
- Locality
- Arkansas
- Physician work
- 1.000
- Practice expense
- 0.859
- Malpractice
- 0.515
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 9.42 | × 1.000 | 9.4200 |
| Practice expense | 3.19 | × 0.859 | 2.7402 |
| Malpractice | 3.20 | × 0.515 | 1.6480 |
| Total RVUs | 13.8082 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Arkansas$461.21
Facility: (9.42 × 1 + 3.19 × 0.859 + 3.2 × 0.515) × $33.4009 = $461.21
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician 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.
How 22208 has changed in Arkansas
22208 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $461.21 | RVU26D |
| 2026-07-01 | Not available in this setting | $461.21 | RVU26C |
| 2026-04-01 | Not available in this setting | $461.21 | RVU26B |
| 2026-01-01 | Not available in this setting | $461.21 | RVU26A |
| 2025-10-01 | Not available in this setting | $502.00 | RVU25D |
| 2025-07-01 | Not available in this setting | $502.00 | RVU25C |
| 2025-04-01 | Not available in this setting | $502.00 | RVU25B |
| 2025-01-01 | Not available in this setting | $502.00 | RVU25A |
| 2024-10-01 | Not available in this setting | $513.29 | RVU24D |
| 2024-07-01 | Not available in this setting | $513.29 | RVU24C |
| 2024-04-01 | Not available in this setting | $513.29 | RVU24B |
| 2024-03-09 | Not available in this setting | $513.29 | RVU24AR |
| 2024-01-01 | Not available in this setting | $504.91 | RVU24A |
| 2023-10-01 | Not available in this setting | $516.37 | RVU23D |
| 2023-07-01 | Not available in this setting | $516.37 | RVU23C |
| 2023-04-01 | Not available in this setting | $516.37 | RVU23B |
| 2023-01-01 | Not available in this setting | $516.37 | RVU23A |
| 2022-10-01 | Not available in this setting | $521.24 | RVU22D |
| 2022-07-01 | Not available in this setting | $521.24 | RVU22C |
| 2022-04-01 | Not available in this setting | $521.24 | RVU22B |
| 2022-01-01 | Not available in this setting | $521.24 | RVU22A |
| 2021-10-01 | Not available in this setting | $524.12 | RVU21D |
| 2021-07-01 | Not available in this setting | $524.12 | RVU21C |
| 2021-04-01 | Not available in this setting | $524.12 | RVU21B |
| 2021-01-01 | Not available in this setting | $524.12 | RVU21A |
| 2020-10-01 | Not available in this setting | $545.44 | RVU20D |
| 2020-07-01 | Not available in this setting | $545.44 | RVU20C |
| 2020-04-01 | Not available in this setting | $545.44 | RVU20B |
| 2020-01-01 | Not available in this setting | $545.44 | RVU20A |
| 2019-10-01 | Not available in this setting | $555.39 | RVU19D |
| 2019-07-01 | Not available in this setting | $555.39 | RVU19C |
| 2019-04-01 | Not available in this setting | $555.39 | RVU19B |
| 2019-01-01 | Not available in this setting | $555.39 | RVU19A |
| 2018-10-01 | Not available in this setting | $556.24 | RVU18D |
| 2018-07-01 | Not available in this setting | $556.24 | RVU18C |
| 2018-04-01 | Not available in this setting | $556.24 | RVU18B |
| 2018-01-01 | Not available in this setting | $556.24 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $546.33 | RVU17D |
| 2017-07-01 | Not available in this setting | $546.33 | RVU17C |
| 2017-04-01 | Not available in this setting | $546.33 | RVU17B |
| 2017-01-01 | Not available in this setting | $546.33 | RVU17A |
| 2016-10-01 | Not available in this setting | $542.48 | RVU16D |
| 2016-07-01 | Not available in this setting | $542.48 | RVU16C |
| 2016-04-01 | Not available in this setting | $542.48 | RVU16B |
| 2016-01-01 | Not available in this setting | $542.48 | RVU16A |
| 2015-10-01 | Not available in this setting | $540.00 | RVU15D |
| 2015-07-01 | Not available in this setting | $540.00 | RVU15C |
| 2015-04-01 | Not available in this setting | $537.31 | RVU15B |
| 2015-01-01 | Not available in this setting | $537.31 | RVU15A |
| 2014-10-01 | Not available in this setting | $537.43 | RVU14D |
| 2014-07-01 | Not available in this setting | $537.43 | RVU14C |
| 2014-04-01 | Not available in this setting | $537.43 | RVU14B |
| 2014-01-01 | Not available in this setting | $537.43 | RVU14A |
| 2013-10-01 | Not available in this setting | $517.82 | RVU13D |
| 2013-07-01 | Not available in this setting | $517.82 | RVU13C |
| 2013-04-01 | Not available in this setting | $517.82 | RVU13B |
| 2013-01-01 | Not available in this setting | $517.82 | RVU13AR |
Where the Arkansas rate applies
Arkansas is a Medicare payment area, not a city. Our Census mapping connects it to 626 cities and communities in Arkansas. Some span more than one payment area; confirm with the service ZIP.
- Acorn
- Adona
- Alexander
- Alicia
- Alix
- Alleene
- Allport
- Alma
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
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