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Billing code 22326: Spine fracture repairMedicare rate & RVUs

Open posterior operative treatment of a cervical vertebral fracture or dislocation, reported when the surgeon reduces or treats the injured cervical segment or segments.

CMS RVU26DEffective Oct 1, 2026109 payment localities2.3K Medicare services in 2024

Medicare pays $1,473.65 for 22326 nationally in a facility.

Medicare rate · 22326

Spine fracture repair

Swap in your local Medicare rate.

Work RVUs
20.32
Total RVUs
44.12
Global days
090

National rate · 2026

$1,473.65

Facility setting, before claim adjustments.

See every locality for 22326 → · 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 22326 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 22326 covers

Code 22326 represents operative treatment or reduction of a cervical vertebral fracture or dislocation through a posterior approach. An orthopedic spine surgeon or neurosurgeon typically performs it in a hospital operating room for an injury requiring open surgical management. It is distinct from closed treatment using manipulation and external immobilization alone.

Report the operation with documentation identifying the cervical injury level or levels, posterior approach, and treatment or reduction performed. Use 22328 for each additional vertebral segment treated. The 90-day global includes the day-before preoperative visit and related postoperative care during the 90 days after surgery. For multiple procedures in the same session, the highest-valued procedure is paid in full and others are subject to the standard 50% reduction. Modifier 50 is inappropriate. An assistant at surgery may be paid; co-surgeon payment requires supporting documentation, and team-surgery payment 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 22326 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

22326 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,297.60
Alaska*Unavailable$1,737.11
ArizonaUnavailable$1,420.96
ArkansasUnavailable$1,276.19
AtlantaUnavailable$1,534.31
AustinUnavailable$1,478.43
BakersfieldUnavailable$1,442.00
Baltimore/Surr. CntysUnavailable$1,583.24
BeaumontUnavailable$1,406.82
BrazoriaUnavailable$1,419.56

22326 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
22326 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 22326 rate is calculated

Each of 22326’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 · 22326

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 20.32Practice expense 16.37Malpractice 7.43

44.1200 adjusted RVUs×$33.4009 conversion factor=$1,473.65

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

Payment rules and modifiers for 22326

22326 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22326

Spine fracture repair

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 · 22326

Spine fracture repair

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.

  • 24 Unrelated E/M visit by the same physician
  • 79 Unrelated procedure (starts its own global period)
  • 58 Staged, more extensive, or therapy procedure that was planned
  • 78 Unplanned 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

22326 without 51 · national facility

$1,473.65

Spine fracture repair

22326-51 · Second procedure: 50%

$736.83

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

22326 compared with similar codes

Compare codes

22326 vs 22325 vs 22327 vs 22328 vs 22318: national Medicare rates

Swap in your local Medicare rate.

  • 22326
    Spine fracture repair · 20.32 wRVU
    —
  • 22325
    Spine fracture · 19.37 wRVU
    —
  • 22327
    Fracture treatment · 20.25 wRVU
    —
  • 22328
    Spine fracture treatment · 4.49 wRVU
    —
  • 22318
    Odontoid fixation · 22.15 wRVU
    —

How to choose

22325Spine fracture
Both describe posterior operative treatment of vertebral fracture or dislocation; 22325 is for lumbar levels, while 22326 is for cervical levels.
22327Fracture treatment
22327 applies to thoracic levels. Use 22326 for cervical injuries treated through a posterior approach.
22328Spine fracture treatment
22328 is an add-on for each additional vertebral segment treated; it is reported with the applicable primary-level code rather than instead of 22326.
22318Odontoid fixation
22318 is for open treatment of an odontoid fracture without graft. Code 22326 describes posterior operative treatment of cervical vertebral fracture or dislocation more broadly.

Codes related to 22326

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

Codes related to 22326
CodeHow it relatesNational office range
Add-on codes
22328Spine fracture treatmentAdd-on code for each additional vertebral segment treated with the primary procedure.No office rate
Same family
22325Spine fracturePosterior operative treatment of vertebral fracture or dislocation at lumbar levels.No office rate
22327Fracture treatmentPosterior operative treatment of vertebral fracture or dislocation at thoracic levels.No office rate
Used instead
22318Odontoid fixationSpecific open treatment option for an odontoid fracture without graft.No office rate
22319Odontoid fracture surgerySpecific open treatment option for an odontoid fracture with graft.No office rate
22310Spine fracture careClosed vertebral fracture treatment without manipulation rather than open posterior surgery.$299.97–$431.07
22315Vertebral fracture careClosed vertebral fracture treatment with manipulation rather than open posterior surgery.$880.57–$1,263.06

22326 billing questions

How is 22326 different from 22325 or 22327?

22326 applies to posterior operative treatment of cervical vertebral injuries. Use 22325 for lumbar injuries and 22327 for thoracic injuries.

When should 22328 be reported with 22326?

Report 22328 for each additional vertebral segment treated beyond the segment represented by the primary procedure. Document the levels treated.

Is 22326 appropriate for closed treatment?

No. It represents open posterior operative treatment. Codes 22310 and 22315 describe closed vertebral fracture treatment, with the distinction based on whether manipulation is performed.

Does the 90-day global include postoperative visits?

Yes. Related postoperative care during the 90 days after surgery is included, along with the day-before preoperative visit.

Can modifier 50 be used for bilateral cervical treatment?

No. The anatomy and service descriptor make modifier 50 inappropriate for 22326.

What documentation supports 22326?

The operative report should identify the cervical fracture or dislocation, the treated level or levels, the posterior approach, and the operative treatment or reduction performed.

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 22326PPRRVU2026_Oct_nonQPP.csv, line 2,067 (RVU26D)

Open CMS sourceHow we calculate rates

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