CPT code 22226: Spinal osteotomy, each additional anterior segment2026 Medicare rate & RVUs in California
Reports each additional vertebral segment treated with an anterior spinal osteotomy and discectomy during multilevel correction of spinal deformity, beyond the primary segment.
CMS doesn’t publish an office rate for 22226 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 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 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 | $306.58 |
| Chico, CA | Unavailable | $301.90 |
| El Centro, CA | Unavailable | $302.19 |
| Fresno, CA | Unavailable | $301.90 |
| Hanford, CA | Unavailable | $301.90 |
| Los Angeles, CA | Unavailable | $319.74 |
| Madera, CA | Unavailable | $301.90 |
| Marin County, CA | Unavailable | $332.93 |
| Merced, CA | Unavailable | $301.90 |
| Modesto, CA | Unavailable | $301.90 |
| Napa, CA | Unavailable | $323.60 |
| Oxnard, CA | Unavailable | $314.72 |
| Redding, CA | Unavailable | $301.90 |
| Rest of California | Unavailable | $301.90 |
| Riverside, CA | Unavailable | $320.73 |
| Sacramento, CA | Unavailable | $309.95 |
| Salinas, CA | Unavailable | $308.71 |
| San Benito County, CA | Unavailable | $342.47 |
| San Diego, CA | Unavailable | $311.25 |
| San Francisco, CA | Unavailable | $330.93 |
| San Luis Obispo, CA | Unavailable | $304.67 |
| Santa Clara County, CA | Unavailable | $334.30 |
| Santa Cruz, CA | Unavailable | $310.35 |
| Santa Maria, CA | Unavailable | $308.57 |
| Santa Rosa, CA | Unavailable | $312.96 |
| Stockton, CA | Unavailable | $301.90 |
| Vallejo, CA | Unavailable | $320.72 |
| Visalia, CA | Unavailable | $301.90 |
| Yuba City, CA | Unavailable | $301.90 |
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
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
| 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
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.
22226 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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