Billing code 22318: Odontoid fixationMedicare rate & RVUs in Guam
Report this operation for anterior surgical reduction and internal fixation of an odontoid fracture when no bone graft is used.
CMS doesn’t publish an office rate for 22318 in Guam.
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 22318 covers
This operation treats a fracture of the odontoid, the upward-projecting portion of C2, through an anterior approach in the neck. The surgeon reduces the fracture and places internal fixation; bone graft is not used. It is typically performed by an orthopedic spine surgeon or neurosurgeon in an operating room for a fracture requiring operative stabilization.
Select this code when the operative report supports an odontoid fracture, an anterior approach, internal fixation, and no graft. The 90-day global period includes the day-before preoperative visit and related postoperative care during the following 90 days. 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 and co-surgeon billing are permitted; team-surgery billing 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.
22318 in Hawaii, Guam
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam | Unavailable | $1,578.66 |
How the 22318 rate is calculated
Each of 22318’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 · 22318
RVUs × geographic indexes × conversion factor
Work22.15
22.15 RVUs× 1.000 GPCI
Practice expense17.52
17.52 RVUs× 1.000 GPCI
Malpractice8.97
8.97 RVUs× 1.000 GPCI
Adjusted RVUs
48.6400
Conversion factor
$33.4009
Medicare rate
$1,624.62
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 22318
22318 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 22318
Odontoid fixation
| 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 · 22318
Odontoid fixation
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
22318 without 51 · national facility
$1,624.62
Odontoid fixation
22318-51 · Second procedure: 50%
$812.31
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%).
22318 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 22319Odontoid fracture surgery
- Both address anterior operative treatment of an odontoid fracture. Choose 22319 when graft is used; choose 22318 when it is not.
- 22326Spine fracture repair
- This code is specific to anterior treatment of an odontoid fracture without graft. Code 22326 describes posterior treatment of a cervical spine fracture.
- 22310Spine fracture care
- 22310 describes closed vertebral fracture treatment without manipulation. It does not represent the anterior operative reduction and fixation reported with 22318.
- 22315Vertebral fracture care
- 22315 describes closed vertebral fracture treatment with manipulation; 22318 represents anterior surgery with internal fixation for an odontoid fracture.
22318 billing questions
When is 22318 chosen instead of 22319?
Use 22318 when the odontoid fracture is treated through an anterior approach with fixation and no graft. The grafted service is represented by 22319.
What operative details support reporting 22318?
Document the odontoid fracture, anterior surgical approach, reduction and internal fixation, and whether graft was used.
Is the day-before visit or routine postoperative care separately included?
The 90-day global period includes the day-before preoperative visit and related postoperative care for 90 days.
How are other procedures in the same session paid?
The highest-valued procedure is paid in full; other procedures in that session are subject to the standard multiple-procedure reduction.
Can an assistant or co-surgeon be reported?
Assistant-at-surgery payment and co-surgeon billing are permitted for this code. Team-surgery billing is not permitted.
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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