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Billing code 22222: Spinal osteotomyMedicare rate & RVUs

Reports an anterior thoracic spinal osteotomy with discectomy at one vertebral segment, typically performed to release a rigid deformity during reconstruction.

CMS RVU26DEffective Oct 1, 2026109 payment localities23 Medicare services in 2024

Medicare pays $1,774.26 for 22222 nationally in a facility.

Medicare rate · 22222

Spinal osteotomy

Work RVUs
22.51
Total RVUs
53.12
Global days
090

National rate · 2026

$1,774.26

Facility setting, before claim adjustments.

See every locality for 22222 →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.

On this page 10 sections
  1. Medicare rate
  2. What 22222 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 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

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

109 of 109 payment localities

22222 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,548.41
Alaska*Unavailable$2,053.54
ArizonaUnavailable$1,706.71
ArkansasUnavailable$1,520.94
AtlantaUnavailable$1,851.57
AustinUnavailable$1,780.48
BakersfieldUnavailable$1,732.16
Baltimore/Surr. CntysUnavailable$1,912.96
BeaumontUnavailable$1,688.27
BrazoriaUnavailable$1,704.12

22222 rates by state

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

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Local rates. Clear comparisons.

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22222 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 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

RuleCMS valueWhat it means
Global period090Major surgery: the day before, the day of, and 90 days after are included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
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.
Split (54/55/56)0.10/0.69/0.21Share of the payment for pre-op, the procedure itself, and post-op care.

Global surgery period · 22222

Spinal osteotomy

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.

  • 24Unrelated E/M visit by the same physician
  • 79Unrelated procedure (starts its own global period)
  • 58Staged, more extensive, or therapy procedure that was planned
  • 78Unplanned return to the operating room for a related complication
SurgeryVisit
Sep 23, 2026Jan 10, 2027

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

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%).

When to use modifier 51

22222 compared with similar codes

Compare codes · National

5 codes, side by side

  • 22222

    Spinal osteotomy22.51 wRVU

    Not priced

  • 22212

    Spinal osteotomy20.47 wRVU

    Not priced

  • 22224

    Spinal osteotomy22.51 wRVU

    Not priced

  • 22226

    Spinal osteotomy5.88 wRVU

    Not priced

  • 22206

    Spinal osteotomy36.25 wRVU

    Not priced

How to choose

22212Spinal osteotomy
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 osteotomy
The approach and one-segment osteotomy are similar, but 22224 identifies the lumbar region; 22222 identifies the thoracic region.
22226Spinal osteotomy
22222 reports the first qualifying thoracic segment. 22226 reports each additional segment and is used as an add-on.
22206Spinal osteotomy
22206 describes a thoracic three-column osteotomy. Choose 22222 for the anterior osteotomy with discectomy at one thoracic segment.

Codes related to 22222

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

Codes related to 22222
CodeHow it relatesNational office range
Add-on codes
22226Spinal osteotomyAdd-on code for each additional segment treated with the qualifying anterior osteotomy.No office rate
Same family
22220Spinal osteotomyAnterior osteotomy with discectomy at one cervical vertebral segment.No office rate
22224Spinal osteotomyAnterior osteotomy with discectomy at one lumbar vertebral segment.No office rate
Used instead
22212Spinal osteotomyThoracic osteotomy through a posterior or posterolateral approach rather than an anterior approach.No office rate
22206Spinal osteotomyThoracic three-column osteotomy, a different and more extensive osteotomy service.No office rate

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
RVUs for 22222PPRRVU2026_Oct_nonQPP.csv, line 2,059 (RVU26D)

Open CMS sourceHow we calculate rates

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