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Billing code 22328: Spine fracture treatmentMedicare rate & RVUs

Reports open posterior treatment of each additional vertebral segment affected by fracture or dislocation during an operation that treats an initial segment.

CMS RVU26DEffective Oct 1, 2026109 payment localities1.2K Medicare services in 2024

Medicare pays $252.51 for 22328 nationally in a facility.

Medicare rate · 22328

Spine fracture treatment

Swap in your local Medicare rate.

Work RVUs
4.49
Total RVUs
7.56
Global days
ZZZ

National rate · 2026

$252.51

Facility setting, before claim adjustments.

See every locality for 22328 → · 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 22328 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 22328 covers

This add-on represents open posterior treatment of an additional vertebral segment affected by fracture or dislocation during the same operative service as the first treated segment. The surgeon addresses the additional injured level through a posterior approach; internal fixation may be included when performed. The service is typically performed in a hospital operating room by an orthopedic spine surgeon or neurosurgeon.

Report 22328 with the applicable primary posterior open-treatment code for the initial cervical, thoracic, or lumbar segment: 22326, 22327, or 22325, respectively. It is not reported alone. Count additional vertebral segments actually treated, and document the injured levels, posterior approach, and treatment performed at each level. CMS identifies this as an add-on code paid 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 22328 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

22328 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$223.59
Alaska*Unavailable$307.38
ArizonaUnavailable$243.44
ArkansasUnavailable$220.13
AtlantaUnavailable$264.24
AustinUnavailable$249.80
BakersfieldUnavailable$239.83
Baltimore/Surr. CntysUnavailable$270.94
BeaumontUnavailable$244.27
BrazoriaUnavailable$241.79

22328 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
22328 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 22328 rate is calculated

Each of 22328’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 · 22328

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 4.49Practice expense 1.51Malpractice 1.56

7.5600 adjusted RVUs×$33.4009 conversion factor=$252.51

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

Payment rules and modifiers for 22328

The CMS indicators that decide how 22328 is paid alongside other services.

CMS payment indicators · 22328

Spine fracture treatment

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

22328 without 80 · national facility

$252.51

Spine fracture treatment

22328-80 · Assistant: 16%

$40.40

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

When to use modifier 80

22328 compared with similar codes

Compare codes

22328 vs 22325 vs 22326 vs 22327 vs 22310: national Medicare rates

Swap in your local Medicare rate.

  • 22328
    Spine fracture treatment · 4.49 wRVU
    —
  • 22325
    Spine fracture · 19.37 wRVU
    —
  • 22326
    Spine fracture repair · 20.32 wRVU
    —
  • 22327
    Fracture treatment · 20.25 wRVU
    —
  • 22310
    Spine fracture care · 3.36 wRVU
    $341.36

How to choose

22325Spine fracture
22325 reports the primary posterior open treatment of an initial lumbar segment; 22328 reports each additional segment treated during that operative service.
22326Spine fracture repair
22326 is the primary code for an initial cervical segment. Use 22328 for additional treated segments, not in place of the primary code.
22327Fracture treatment
22327 is the primary code for an initial thoracic segment; 22328 captures additional treated segments.
22310Spine fracture care
22310 describes closed fracture treatment, whereas 22328 applies to an additional segment treated through the open posterior operative service.

Codes related to 22328

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

Codes related to 22328
CodeHow it relatesNational office range
Add-on codes
22325Spine fracturePrimary posterior open-treatment code for the initial lumbar segment.No office rate
22326Spine fracture repairPrimary posterior open-treatment code for the initial cervical segment.No office rate
22327Fracture treatmentPrimary posterior open-treatment code for the initial thoracic segment.No office rate
Used instead
22310Spine fracture careClosed vertebral fracture treatment in a different treatment circumstance.$299.97–$431.07
22315Vertebral fracture careClosed vertebral fracture treatment with manipulation rather than additional open treatment.$880.57–$1,263.06

22328 billing questions

Which primary code is reported with 22328?

Pair it with the primary posterior open-treatment code for the initial segment: 22325 for lumbar, 22326 for cervical, or 22327 for thoracic treatment.

Can 22328 be reported by itself?

No. It is an add-on for treatment of an additional vertebral segment and must be billed with the applicable primary procedure.

How many units should be reported?

Report each additional vertebral segment treated beyond the initial segment. The operative report should support the specific additional levels treated.

Does instrumentation alone support 22328?

No. The additional segment must undergo treatment for a fracture or dislocation; hardware placement alone does not describe the service.

What documentation supports the add-on?

Document the fracture or dislocation level, the posterior approach, and the treatment performed at each additional vertebral segment.

How does the global period affect payment?

CMS pays 22328 within the global period of the primary procedure. It is not a stand-alone service.

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 22328PPRRVU2026_Oct_nonQPP.csv, line 2,069 (RVU26D)

Open CMS sourceHow we calculate rates

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