Billing code 22837: Vertebral tetheringMedicare rate & RVUs in Illinois
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 doesn’t publish an office rate for 22837 in Illinois.
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 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 in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | Unavailable | $1,831.64 |
| East St. Louis | Unavailable | $1,756.38 |
| Rest Of Illinois | Unavailable | $1,698.12 |
| Suburban Chicago | Unavailable | $1,775.60 |
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
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
| 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) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 2 | Permitted. |
| Team surgery (66) | 1 | Permitted with supporting documentation. |
| 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 · 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.
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%).
22837 compared with similar codes
Compare codes
22837 vs 22836 vs 22838 vs 22840: national Medicare rates
Swap in your local Medicare rate.
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.
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
Fee sheets
Put 22837 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →