No office rate
22206 reports the primary thoracic three-column osteotomy segment. Use 22208 for each additional segment treated with that technique.
On this page
CMS RVU26D · Effective 2026-10-01
22208 Spinal osteotomy Medicare reimbursement rates in California
Reports an additional vertebral segment treated with a three-column spinal osteotomy during posterior or posterolateral surgery for rigid spinal deformity. Compare 22208 office and facility rates across CMS payment localities in California.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 22208 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$494.05–$560.18
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $66.13 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 22208 pays more and less in California
Spine surgery
About 22208: Additional three-column spinal osteotomy
Reports an additional vertebral segment treated with a three-column spinal osteotomy during posterior or posterolateral surgery for rigid spinal deformity.
A three-column osteotomy removes bone through the front, middle, and back columns of the spine to help correct a rigid deformity, such as fixed kyphosis or scoliosis. Spine surgeons typically perform the procedure through a posterior or posterolateral approach during complex reconstructive surgery. Code 22208 represents an additional vertebral segment treated with this osteotomy, beyond the segment represented by the primary procedure.
Report 22208 only with an appropriate primary three-column osteotomy code, such as 22206 for a thoracic segment or 22207 for a lumbar segment. The operative report should identify the spinal levels treated and document the additional osteotomy work; the number of fusion levels alone does not establish the number of osteotomy segments. CMS classifies 22208 as an add-on code, so it is billed with a primary procedure and paid within that procedure’s global period.
CMS billing rules for 22208
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU9.42 · 60%
- Practice expense (office) RVU3.19 · 20%
- Malpractice RVU3.20 · 20%
219
Medicare services in 2024 · #4242 by national volume
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.
22208 compared with similar codes
Office rates for California, from the same CMS release.
No office rate
22207 reports the primary lumbar three-column osteotomy segment. 22208 represents an additional segment, not the primary lumbar work.
No office rate
22216 is an additional-segment code for another posterior or posterolateral osteotomy family; 22208 is specific to additional three-column osteotomy work.
No office rate
22214 represents a single lumbar segment in the posterior or posterolateral osteotomy family. 22208 is for an additional segment treated with a three-column osteotomy.
Compare 22208 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office Unavailable | Facility $502.48 |
| Chico | Office Unavailable | Facility $494.05 |
| El Centro | Office Unavailable | Facility $494.59 |
| Fresno | Office Unavailable | Facility $494.05 |
| Hanford-Corcoran | Office Unavailable | Facility $494.05 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $524.55 |
| Madera | Office Unavailable | Facility $494.05 |
| Merced | Office Unavailable | Facility $494.05 |
| Modesto | Office Unavailable | Facility $494.05 |
| Napa | Office Unavailable | Facility $529.19 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $515.98 |
| Redding | Office Unavailable | Facility $494.05 |
| Rest Of California | Office Unavailable | Facility $494.05 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $528.25 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $507.17 |
| Salinas | Office Unavailable | Facility $505.17 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $509.44 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $543.82 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $540.19 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $560.18 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $545.32 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $498.63 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $507.99 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $504.97 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $512.21 |
| Stockton | Office Unavailable | Facility $494.05 |
| Vallejo | Office Unavailable | Facility $523.95 |
| Visalia | Office Unavailable | Facility $494.05 |
| Yuba City | Office Unavailable | Facility $494.05 |
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22208 billing questions
Can 22208 be billed by itself?
No. It is an add-on code and must be reported with an eligible primary three-column osteotomy, such as 22206 or 22207.
How is 22208 different from 22207?
22207 represents the primary three-column osteotomy at a lumbar segment. Use 22208 for an additional segment treated with the three-column technique.
Does the number of fused levels determine the units?
No. Document the vertebral segments where the additional three-column osteotomy was performed; fusion levels alone do not establish osteotomy units.
What documentation supports reporting 22208?
The operative report should identify the additional vertebral level and describe the three-column osteotomy performed there, along with the approach and primary procedure.
How does 22208 differ from 22216?
Both represent additional osteotomy segments, but 22208 belongs to the three-column osteotomy family. Code 22216 is used with a different posterior or posterolateral osteotomy family.
How does CMS treat payment for this add-on code?
CMS identifies 22208 as payable only with a primary procedure and within that procedure’s 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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
2,05022116,,Remove extra spine segment,A,,2.26,0.75,NA,0.75,,0.76,3.77,3.77,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05122206,,Incis spine 3 column thorac,A,,36.25,20.14,NA,20.14,,12.03,68.42,68.42,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05222207,,Incis spine 3 column lumbar,A,,35.76,19.61,NA,19.61,,10.93,66.30,66.30,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05322208,,Incis spine 3 column adl seg,A,,9.42,3.19,NA,3.19,,3.20,15.81,15.81,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05422210,,Incis 1 vertebral seg cerv,A,,24.75,18.44,NA,18.44,,8.11,51.30,51.30,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05522212,,Incis 1 vertebral seg thorac,A,,20.47,16.78,NA,16.78,,6.34,43.59,43.59,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05622214,,Incis 1 vertebral seg lumbar,A,,20.49,16.58,NA,16.58,,6.17,43.24,43.24,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00