No office rate
Both describe a cervical osteotomy with disc removal, but 22210 is the posterior-approach service; 22220 is anterior.
On this page
CMS RVU26D · Effective 2026-10-01
22220 Spinal osteotomy Medicare reimbursement rates in Hawaii
Report an anterior cervical osteotomy with disc removal when a surgeon releases one vertebral segment to correct a fixed cervical deformity. Compare 22220 office and facility rates across CMS payment localities in Hawaii.
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 22220 in Hawaii?
Hawaii has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$1538.43
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
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.
Spine surgery
About 22220: Anterior cervical vertebral osteotomy
Report an anterior cervical osteotomy with disc removal when a surgeon releases one vertebral segment to correct a fixed cervical deformity.
This service involves an anteriorly approached osteotomy at one cervical vertebral segment, with removal of the intervening disc as part of the release. A spine surgeon may perform it to mobilize a fixed deformity, such as cervical kyphosis, when correction requires an osteotomy rather than routine disc decompression. It is performed in the operating room and may be part of a larger reconstruction or fusion procedure.
Report one unit for the cervical segment actually osteotomized. The operative report should identify the treated level, anterior approach, bony release, associated disc removal, and correction performed. Routine cervical discectomy and fusion without an osteotomy is not this service; 22226 describes each additional segment. CMS assigns a 90-day global period, including the day-before preoperative visit and 90 days of related postoperative care. For multiple procedures in one session, the highest-valued procedure is paid in full and others at 50%. An assistant at surgery may be paid; co-surgeons require supporting documentation, and team surgery is not permitted.
CMS billing rules for 22220
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Assistant at surgery may be paid.
- Co-surgeons
- Co-surgeons paid only with supporting documentation.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU22.37 · 48%
- Practice expense (office) RVU17.24 · 37%
- Malpractice RVU7.06 · 15%
503
Medicare services in 2024 · #3558 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.
22220 compared with similar codes
Office rates for Hawaii, from the same CMS release.
No office rate
This is the corresponding anterior osteotomy for a thoracic segment. Use 22220 for a cervical segment.
No office rate
22220 describes the first cervical segment; 22226 describes each additional anterior osteotomy segment.
No office rate
22551 describes anterior cervical discectomy and fusion, not an osteotomy for deformity release. Report 22220 only when the operative work includes the osteotomy.
Compare 22220 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.
1 of 1 payment localities
Hawaii, Guam →
Office / nonfacility
Unavailable
Facility
$1538.43
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 22220 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
2,058
- Code
- 22220
- Physician work
- 22.37
- Practice expense
- 17.24
- Malpractice
- 7.06
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 22.37 | × 1.000 | 22.3700 |
| Practice expense | 17.24 | × 1.137 | 19.6019 |
| Malpractice | 7.06 | × 0.579 | 4.0877 |
| Total RVUs | 46.0596 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Hawaii, Guam$1538.43
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 22.37 | 1 |
| Practice expense | 17.24 | 1.137 |
| Malpractice | 7.06 | 0.579 |
(22.37 × 1 + 17.24 × 1.137 + 7.06 × 0.579) × $33.4009 = $1538.43
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
22220 billing questions
How is 22220 different from routine anterior cervical discectomy and fusion?
22220 requires an osteotomy to release a cervical vertebral segment for deformity correction. Routine disc removal and fusion without that osteotomy is not enough to report it.
Does 22220 include removal of the disc?
Yes. Disc removal at the treated segment is part of the osteotomy service; do not separately report that same disc removal as a separate service.
When is 22226 used with 22220?
Use 22220 for the first anterior cervical segment osteotomized and 22226 for each additional segment when documented.
What operative documentation supports 22220?
Document the cervical level, anterior approach, vertebral osteotomy and associated disc removal, and the deformity release or correction performed.
Can an assistant or co-surgeon be reported?
An assistant at surgery may be paid. Co-surgeons are paid only with supporting documentation; team surgery is not permitted.
How does the global period affect postoperative billing?
The 90-day global includes the day-before preoperative visit and 90 days of related postoperative care.
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.
2,05522212,,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
2,05722216,,Incis addl spine segment,A,,5.88,1.95,NA,1.95,,1.77,9.60,9.60,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05822220,,Osteot dsc ant 1 vrt sgm crv,A,,22.37,17.24,NA,17.24,,7.06,46.67,46.67,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,05922222,,Osteot dsc ant 1vrt sgm thrc,A,,22.51,21.11,NA,21.11,,9.50,53.12,53.12,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,06022224,,Osteot dsc ant 1vrt sgm lmbr,A,,22.51,16.07,NA,16.07,,5.74,44.32,44.32,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,06122226,,Osteot dsc ant 1vrt sgm ea,A,,5.88,1.93,NA,1.93,,1.76,9.57,9.57,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014