CPT code 22222: Spinal osteotomy, anterior thoracic, one segment2026 Medicare rate & RVUs in California
Reports an anterior thoracic spinal osteotomy with discectomy at one vertebral segment, typically performed to release a rigid deformity during reconstruction.
CMS doesn’t publish an office rate for 22222 in California.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 22222 covers
A spine surgeon uses an anterior approach to perform an osteotomy at one thoracic vertebral segment, including the discectomy associated with the release. The procedure may be part of reconstruction for a rigid thoracic deformity, such as scoliosis or kyphosis, when anterior release is needed to help mobilize the spine. It is generally performed in a hospital operating room with an anterior exposure of the thoracic spine.
Select this code when the documented work is an anterior osteotomy at a single thoracic segment. The operative report should establish the spinal region, anterior approach, segment treated, and osteotomy and discectomy performed. This major surgery has a 90-day global period that includes the day-before preoperative visit and 90 days of related postoperative care. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this spinal segment service. Assistant-at-surgery payment may be made; co-surgeon payment requires supporting documentation, and team surgery is not permitted.
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 22222 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | Unavailable | $1,732.16 |
| Chico, CA | Unavailable | $1,707.50 |
| El Centro, CA | Unavailable | $1,709.08 |
| Fresno, CA | Unavailable | $1,707.50 |
| Hanford, CA | Unavailable | $1,707.50 |
| Los Angeles, CA | Unavailable | $1,827.50 |
| Madera, CA | Unavailable | $1,707.50 |
| Marin County, CA | Unavailable | $1,963.11 |
| Merced, CA | Unavailable | $1,707.50 |
| Modesto, CA | Unavailable | $1,707.50 |
| Napa, CA | Unavailable | $1,889.73 |
| Oxnard, CA | Unavailable | $1,804.01 |
| Redding, CA | Unavailable | $1,707.50 |
| Rest of California | Unavailable | $1,707.50 |
| Riverside, CA | Unavailable | $1,808.83 |
| Sacramento, CA | Unavailable | $1,769.02 |
| Salinas, CA | Unavailable | $1,762.44 |
| San Benito County, CA | Unavailable | $2,021.38 |
| San Diego, CA | Unavailable | $1,789.68 |
| San Francisco, CA | Unavailable | $1,952.32 |
| San Luis Obispo, CA | Unavailable | $1,737.81 |
| Santa Clara County, CA | Unavailable | $1,977.27 |
| Santa Cruz, CA | Unavailable | $1,794.41 |
| Santa Maria, CA | Unavailable | $1,765.12 |
| Santa Rosa, CA | Unavailable | $1,810.34 |
| Stockton, CA | Unavailable | $1,707.50 |
| Vallejo, CA | Unavailable | $1,874.18 |
| Visalia, CA | Unavailable | $1,707.50 |
| Yuba City, CA | Unavailable | $1,707.50 |
How the 22222 rate is calculated
Each of 22222’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 · 22222
RVUs × geographic indexes × conversion factor
Work22.51
22.51 RVUs× 1.000 GPCI
Practice expense21.11
21.11 RVUs× 1.000 GPCI
Malpractice9.50
9.50 RVUs× 1.000 GPCI
Adjusted RVUs
53.1200
Conversion factor
$33.4009
Medicare rate
$1,774.26
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 22222
22222 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 22222
Spinal osteotomy, anterior thoracic, one segment
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| 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. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share of the payment for pre-op, the procedure itself, and post-op care. |
Global surgery period · 22222
Spinal osteotomy, anterior thoracic, one segment
90-day global period ends
Dec 30, 2026
Covers Sep 30, 2026 through Dec 30, 2026 (92 days, including the day before surgery).
Visit on Oct 31, 2026
Day 30 of the 90-day post-op period: related follow-up care is included in the surgical payment.
Pre-op dayGlobal period
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
22222 without 51 · national facility
$1,774.26
Spinal osteotomy, anterior thoracic, one segment
22222-51 · Second procedure: 50%
$887.13
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
22222 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 22212Spinal osteotomySingle thoracic segment
- Use 22222 for the anterior thoracic osteotomy that includes discectomy. Use 22212 when the thoracic osteotomy is performed through a posterior or posterolateral approach.
- 22224Spinal osteotomyAnterior, single lumbar segment
- The approach and one-segment osteotomy are similar, but 22224 identifies the lumbar region; 22222 identifies the thoracic region.
- 22226Spinal osteotomyEach additional anterior segment
- 22222 reports the first qualifying thoracic segment. 22226 reports each additional segment and is used as an add-on.
- 22206Spinal osteotomyThoracic, one segment
- 22206 describes a thoracic three-column osteotomy. Choose 22222 for the anterior osteotomy with discectomy at one thoracic segment.
22222 billing questions
How does this differ from 22212?
22222 describes an anterior thoracic osteotomy that includes discectomy. 22212 is a thoracic osteotomy performed through a posterior or posterolateral approach.
Can the discectomy be billed separately?
The discectomy associated with this anterior osteotomy is included in the service. The operative report should document it as part of the osteotomy rather than treating it as a separate service.
When should 22226 be reported with 22222?
22226 is the add-on code for each additional vertebral segment treated with the qualifying anterior osteotomy. Report 22222 for the first thoracic segment and document the additional segment work.
Should modifier 50 be appended for bilateral thoracic work?
No. Modifier 50 is inappropriate because this code identifies a spinal segment, not paired anatomy.
What postoperative care is included?
The 90-day global period includes the day-before preoperative visit and 90 days of related postoperative care.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment may be made. Co-surgeon payment requires supporting documentation, and the service cannot be billed as team surgery.
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
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