Billing code 22319: Odontoid fracture surgeryMedicare rate & RVUs in Delaware
Open surgical treatment of a C2 odontoid fracture with bone grafting, reported when the operative repair includes graft rather than treatment without graft.
CMS doesn’t publish an office rate for 22319 in Delaware.
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 9 sections
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.
22319 in Delaware
| Payment locality | Office | Facility |
|---|---|---|
| Delaware | Unavailable | $1,770.96 |
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
Swap in your local Medicare rate.
Work 24.70Practice expense 19.05Malpractice 10.43
All indexes start 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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 090 | Major surgery: the day before, the day of, and 90 days after are included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
| Split (54/55/56) | 0.10/0.69/0.21 | Share 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.
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%).
22319 compared with similar codes
Compare codes
22319 vs 22318 vs 22310 vs 22315 vs 22326: national Medicare rates
Swap in your local Medicare rate.
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.
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
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