Billing code 22838: Tether revisionMedicare rate & RVUs in Oregon
Reports revision, replacement, or removal of an existing thoracic vertebral body tethering construct, including its instrumentation, during spine surgery.
CMS doesn’t publish an office rate for 22838 in Oregon.
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 22838 covers
A spine surgeon reports this service when operating on an existing thoracic vertebral body tethering construct to revise it, replace it, or remove it. Vertebral body tethering uses instrumentation attached to thoracic vertebrae to address spinal curvature; this code is for work on that existing construct, not its initial placement. The service is typically performed in an operating room by an orthopedic spine surgeon or neurosurgeon.
Document the prior tethering construct and the specific revision, replacement, or removal performed. The code has a 90-day global period, including the day-before preoperative visit and related postoperative care. When multiple procedures occur in one session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate for this service. Assistant-at-surgery payment requires medical-necessity documentation; 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 22838 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | Unavailable | $1,713.66 |
| Rest Of Oregon | Unavailable | $1,645.33 |
How the 22838 rate is calculated
Each of 22838’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 · 22838
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 35.10Practice expense 11.57Malpractice 3.75
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 22838
22838 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 22838
Tether revision
| 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 · 22838
Tether revision
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
22838 without 51 · national facility
$1,684.07
Tether revision
22838-51 · Second procedure: 50%
$842.04
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%).
22838 compared with similar codes
Compare codes
22838 vs 22836 vs 22837 vs 22855: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 22836Vertebral tethering
- 22836 describes initial thoracic vertebral body tethering across 2 to 3 vertebral segments. Use 22838 for revision, replacement, or removal of an existing tether construct.
- 22837Vertebral tethering
- 22837 describes initial thoracic vertebral body tethering across 4 or more vertebral segments. It is not the code for later work on an existing construct.
- 22855Hardware removal
- 22855 applies to removal of anterior spinal instrumentation. 22838 is specific to revision, replacement, or removal of thoracic vertebral body tethering.
22838 billing questions
How is this different from 22836 or 22837?
22838 covers revision, replacement, or removal of an existing thoracic tether construct. Codes 22836 and 22837 describe initial thoracic vertebral body tethering, distinguished by the number of vertebral segments.
Can this be reported for removal of other spinal hardware?
No. This code is specific to thoracic vertebral body tethering. Removal of other anterior or posterior spinal instrumentation may fall under a different instrumentation-removal code.
Should modifier 50 be appended?
No. The CMS bilateral adjustment does not apply; modifier 50 is inappropriate for this service.
What documentation supports reporting 22838?
The operative report should identify the existing thoracic tether construct and describe whether it was revised, replaced, or removed.
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.
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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