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Billing code 22319: Odontoid fracture surgeryMedicare rate & RVUs

Open surgical treatment of a C2 odontoid fracture with bone grafting, reported when the operative repair includes graft rather than treatment without graft.

CMS RVU26DEffective Oct 1, 2026109 payment localities24 Medicare services in 2024

Medicare pays $1,809.66 for 22319 nationally in a facility.

Medicare rate · 22319

Odontoid fracture surgery

Work RVUs
24.7
Total RVUs
54.18
Global days
090

National rate · 2026

$1,809.66

Facility setting, before claim adjustments.

See every locality for 22319 →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 22319 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 22319 covers

This code describes open surgical treatment of an odontoid fracture—the dens portion of the C2 vertebra—with bone grafting. A spine surgeon, commonly an orthopedic spine surgeon or neurosurgeon, performs the operation in a hospital operating room. Reduction and stabilization may be part of the repair; internal fixation is included when performed. The graft distinguishes this service from odontoid-fracture treatment without graft.

Report the code when the operative record supports open treatment of an odontoid fracture and documents graft use. The code has a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in the same session, Medicare pays the highest-valued procedure in full and reduces others to 50%. Modifier 50 is inappropriate. Assistant-at-surgery payment may be available, co-surgeons are permitted, 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 22319 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

22319 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,578.93
Alaska*Unavailable$2,107.10
ArizonaUnavailable$1,739.77
ArkansasUnavailable$1,550.98
AtlantaUnavailable$1,892.34
AustinUnavailable$1,808.50
BakersfieldUnavailable$1,750.21
Baltimore/Surr. CntysUnavailable$1,951.87
BeaumontUnavailable$1,727.66
BrazoriaUnavailable$1,733.89

22319 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.

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
22319 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 22319 rate is calculated

Each of 22319’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 · 22319

RVUs × geographic indexes × conversion factor

Work24.70

24.70 RVUs× 1.000 GPCI

Practice expense19.05

19.05 RVUs× 1.000 GPCI

Malpractice10.43

10.43 RVUs× 1.000 GPCI

Adjusted RVUs

54.1800

Conversion factor

$33.4009

Medicare rate

$1,809.66

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

Payment rules and modifiers for 22319

22319 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22319

Odontoid fracture surgery

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)2Permitted.
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 · 22319

Odontoid fracture surgery

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

22319 without 51 · national facility

$1,809.66

Odontoid fracture surgery

22319-51 · Second procedure: 50%

$904.83

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

22319 compared with similar codes

Compare codes · National

5 codes, side by side

  • 22319

    Odontoid fracture surgery24.7 wRVU

    Not priced

  • 22318

    Odontoid fixation22.15 wRVU

    Not priced

  • 22310

    Spine fracture care3.36 wRVU

    $341.36

  • 22315

    Vertebral fracture care9.86 wRVU

    $1,005.03

  • 22326

    Spine fracture repair20.32 wRVU

    Not priced

How to choose

22318Odontoid fixation
Use 22319 when graft is used in open odontoid-fracture treatment. Use 22318 for the corresponding open treatment without graft.
22310Spine fracture care
22310 describes closed vertebral-fracture treatment without manipulation. 22319 is open treatment of an odontoid fracture with graft.
22315Vertebral fracture care
22315 describes closed vertebral-fracture treatment with manipulation; it is not the open grafted odontoid repair represented by 22319.
22326Spine fracture repair
22326 is for open treatment of a cervical spine fracture, while 22319 specifically identifies open treatment of an odontoid fracture with graft.

Codes related to 22319

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

Codes related to 22319
CodeHow it relatesNational office range
Same family
22318Odontoid fixationOpen odontoid-fracture treatment without graft; the closest sibling code.No office rate
Used instead
22310Spine fracture careClosed vertebral-fracture treatment without manipulation, rather than open treatment with graft.$299.97–$431.07
22315Vertebral fracture careClosed vertebral-fracture treatment with manipulation, rather than open treatment with graft.$880.57–$1,263.06
22326Spine fracture repairOpen treatment of a cervical spine fracture outside this odontoid-specific service.No office rate

22319 billing questions

How is this code distinguished from 22318?

Both describe open treatment of an odontoid fracture. Choose 22319 when the operative record documents graft use; 22318 is the corresponding treatment without graft.

What documentation supports reporting 22319?

The operative report should identify the odontoid fracture, describe the open treatment, and document that bone graft was used. It should also describe the repair and any fixation performed.

Is internal fixation separately represented by this code?

Internal fixation, when performed as part of the odontoid-fracture repair, is included in the service. The defining distinction from 22318 is use of graft.

Can modifier 50 be reported?

No. The CMS bilateral adjustment does not apply to this code, and modifier 50 is inappropriate for the odontoid-fracture service.

How are assistant and co-surgeon claims handled?

CMS permits payment for an assistant at surgery and permits co-surgeons. Team surgery is not permitted for this code.

What happens when other procedures are performed in the same session?

Under the standard multiple-procedure reduction, the highest-valued procedure is paid in full and other procedures are paid at 50%. Related postoperative care is included in this code's 90-day 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

Show the CMS file lines behind this rate
RVUs for 22319PPRRVU2026_Oct_nonQPP.csv, line 2,065 (RVU26D)

Open CMS sourceHow we calculate rates

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