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Billing code 22837: Vertebral tetheringMedicare rate & RVUs

Reports anterior thoracic vertebral body tethering across eight or more vertebral segments, a growth-modulating operation commonly used for scoliosis in skeletally immature patients.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $1,662.03 for 22837 nationally in a facility.

Medicare rate · 22837

Vertebral tethering

Swap in your local Medicare rate.

Work RVUs
34.61
Total RVUs
49.76
Global days
090

National rate · 2026

$1,662.03

Facility setting, before claim adjustments.

See every locality for 22837 → · 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 22837 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 22837 covers

The surgeon places a flexible tether along the front of the thoracic spine, securing it to vertebral bodies to guide spinal growth and address scoliosis. The operation is generally considered for skeletally immature patients with progressive scoliosis; it may be performed through an open approach or with thoracoscopy. The code includes thoracoscopy when performed and represents a construct spanning eight or more vertebral segments.

Select this code from the documented extent of the tethered construct, not from the number of incisions or the diagnosis alone. The operative report should identify the vertebral levels and support the segment count. The related lower-extent code, 22836, is used for two to seven segments. This is major surgery with a 90-day global period, including 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. Assistant-at-surgery payment requires documentation of medical necessity; co-surgeons are permitted, and team surgery requires supporting documentation.

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 22837 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

22837 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$1,560.69
Alaska*Unavailable$2,209.57
ArizonaUnavailable$1,632.41
ArkansasUnavailable$1,548.28
AtlantaUnavailable$1,696.39
AustinUnavailable$1,672.49
BakersfieldUnavailable$1,672.55
Baltimore/Surr. CntysUnavailable$1,737.68
BeaumontUnavailable$1,618.83
BrazoriaUnavailable$1,640.72

22837 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
22837 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 22837 rate is calculated

Each of 22837’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 · 22837

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 34.61Practice expense 11.46Malpractice 3.69

49.7600 adjusted RVUs×$33.4009 conversion factor=$1,662.03

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

Payment rules and modifiers for 22837

22837 has a 90-day global period: related visits in that window are included in the surgery payment.

CMS payment indicators · 22837

Vertebral tethering

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)0Not paid without supporting documentation.
Co-surgeons (62)2Permitted.
Team surgery (66)1Permitted with supporting documentation.
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 · 22837

Vertebral tethering

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

22837 without 51 · national facility

$1,662.03

Vertebral tethering

22837-51 · Second procedure: 50%

$831.02

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

22837 compared with similar codes

Compare codes

22837 vs 22836 vs 22838 vs 22840: national Medicare rates

Swap in your local Medicare rate.

  • 22837
    Vertebral tethering · 34.61 wRVU
    —
  • 22836
    Vertebral tethering · 31.2 wRVU
    —
  • 22838
    Tether revision · 35.1 wRVU
    —
  • 22840
    Spinal fixation · 12.21 wRVU
    —

How to choose

22836Vertebral tethering
Both report anterior thoracic vertebral body tethering, including thoracoscopy when performed. Choose 22836 for two to seven segments and 22837 for eight or more.
22838Tether revision
22837 reports the initial tethering construct across eight or more segments. Use 22838 for revision, replacement, or removal of thoracic vertebral body tethering.
22840Spinal fixation
22840 describes insertion of a nonsegmental spinal fixation device, not the anterior thoracic vertebral body tethering construct reported by 22837.

Codes related to 22837

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

Codes related to 22837
CodeHow it relatesNational office range
Same family
22836Vertebral tetheringAnterior thoracic vertebral body tethering for a shorter construct of two to seven segments.No office rate
22838Tether revisionRelated thoracic tethering code for revision, replacement, or removal rather than initial placement.No office rate

22837 billing questions

When should 22837 be selected instead of 22836?

Use 22837 when the anterior thoracic tether construct spans eight or more vertebral segments. Code 22836 is for two to seven segments; use the operative report’s documented levels to establish the count.

Does 22837 include thoracoscopy?

Yes. The code includes thoracoscopy when performed as part of the anterior thoracic vertebral body tethering procedure.

What documentation supports the segment level?

The operative report should identify the vertebral levels included in the tether construct and show that the construct spans at least eight segments.

How does the 90-day global period affect postoperative billing?

The day-before preoperative visit and 90 days of related postoperative care are included in the global period.

Can an assistant or another surgeon be reported?

Assistant-at-surgery payment requires documentation of medical necessity. Co-surgeons are permitted, while team surgery requires supporting documentation.

How are other procedures in the same session paid?

The highest-valued procedure is paid in full, and other procedures performed in the same session are subject to the standard multiple-procedure reduction.

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 22837PPRRVU2026_Oct_nonQPP.csv, line 2,110 (RVU26D)

Open CMS sourceHow we calculate rates

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