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CPT code 22226: Spinal osteotomy, each additional anterior segment2026 Medicare rate & RVUs

Reports each additional vertebral segment treated with an anterior spinal osteotomy and discectomy during multilevel correction of spinal deformity, beyond the primary segment.

CMS RVU26DEffective Oct 1, 2026109 payment localities652 Medicare services in 2024

Medicare pays $319.65 for 22226 nationally in a facility.

Medicare rate · 22226

Spinal osteotomy, each additional anterior segment

Office or facility?

Work RVUs
5.88
Total RVUs
9.57
Global days
ZZZ

National rate · 2026

$319.65

Facility setting, before claim adjustments.

See every locality for 22226 →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 22226 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 22226 covers

This add-on describes an additional vertebral segment treated with an anterior spinal osteotomy that includes discectomy. Spine surgeons, including orthopedic spine surgeons and neurosurgeons, may perform the work during surgery to mobilize the spine for correction of a deformity such as scoliosis or kyphosis. It is typically performed in an operating room as part of a multilevel anterior spinal procedure.

Report it only for additional segments beyond the first, with the applicable primary anterior osteotomy code for the cervical, thoracic, or lumbar region. The operative report should identify the approach, the vertebral levels treated, and the osteotomy and discectomy work at each additional segment. Do not report it by itself. CMS classifies the code as an add-on, so payment is within the primary 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 22226 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

22226 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$286.08
AlaskaUnavailable$395.64
ArizonaUnavailable$309.18
ArkansasUnavailable$282.05
Atlanta, GAUnavailable$333.08
Austin, TXUnavailable$317.08
Bakersfield, CAUnavailable$306.58
Baltimore area, MDUnavailable$341.43
Beaumont, TXUnavailable$309.67
Brazoria, TXUnavailable$307.70

22226 rates by state

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

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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
22226 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 22226 rate is calculated

Each of 22226’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 · 22226

RVUs × geographic indexes × conversion factor

Office or facility?

Work5.88

5.88 RVUs× 1.000 GPCI

Practice expense1.93

1.93 RVUs× 1.000 GPCI

Malpractice1.76

1.76 RVUs× 1.000 GPCI

Adjusted RVUs

9.5700

Conversion factor

$33.4009

Medicare rate

$319.65

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

Payment rules and modifiers for 22226

The CMS indicators that decide how 22226 is paid alongside other services.

CMS payment indicators · 22226

Spinal osteotomy, each additional anterior 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

22226 without 80 · national facility

$319.65

Spinal osteotomy, each additional anterior segment

22226-80 · Assistant: 16%

$51.14

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

When to use modifier 80

22226 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 22226

    Spinal osteotomy, each additional anterior segment5.88 wRVU

    Not priced

  • 22220

    Spinal osteotomy, anterior cervical, one segment22.37 wRVU

    Not priced

  • 22222

    Spinal osteotomy, anterior thoracic, one segment22.51 wRVU

    Not priced

  • 22224

    Spinal osteotomy, anterior, single lumbar segment22.51 wRVU

    Not priced

  • 22216

    Spinal osteotomy, each additional segment5.88 wRVU

    Not priced

How to choose

22220Spinal osteotomyAnterior cervical, one segment
Use 22220 for the primary cervical anterior osteotomy segment; 22226 reports additional segments, not the first one.
22222Spinal osteotomyAnterior thoracic, one segment
Use 22222 for the primary thoracic anterior osteotomy segment. Add 22226 for qualifying additional segments.
22224Spinal osteotomyAnterior, single lumbar segment
Use 22224 for the primary lumbar anterior osteotomy segment; 22226 applies to additional segments.
22216Spinal osteotomyEach additional segment
22216 reports additional posterior or posterolateral osteotomy segments. Choose 22226 for additional segments treated through the anterior approach with discectomy.

Codes related to 22226

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

Codes related to 22226
CodeHow it relatesNational office range
Add-on codes
22220Spinal osteotomy, anterior cervical, one segmentPrimary anterior osteotomy code for the cervical region.No office rate
22222Spinal osteotomy, anterior thoracic, one segmentPrimary anterior osteotomy code for the thoracic region.No office rate
22224Spinal osteotomy, anterior, single lumbar segmentPrimary anterior osteotomy code for the lumbar region.No office rate
Used instead
22216Spinal osteotomy, each additional segmentAdditional-segment osteotomy code for a posterior or posterolateral approach.No office rate

22226 billing questions

Which primary code must accompany 22226?

Pair it with the anterior osteotomy code for the first segment: 22220 for cervical, 22222 for thoracic, or 22224 for lumbar.

When is another unit of 22226 supported?

Report an additional unit for each additional vertebral segment treated beyond the first. The operative note should make the treated levels and work at each segment clear.

Can 22226 be reported by itself?

No. It is an add-on code and must be reported with the applicable primary anterior osteotomy code.

Is the discectomy separately reported at these segments?

The osteotomy service represented by 22226 includes discectomy. Document that work as part of the additional segment rather than reporting it as a separate service.

How does 22226 differ from 22216?

22226 is for additional segments treated through an anterior approach with discectomy. Code 22216 is an additional-segment code for a posterior or posterolateral osteotomy.

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 22226PPRRVU2026_Oct_nonQPP.csv, line 2,061 (RVU26D)

Open CMS sourceHow we calculate rates

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