No office rate
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.
On this page
CMS RVU26D · Effective 2026-10-01
22838 Tether revision Medicare reimbursement rates in Rhode Island
Reports revision, replacement, or removal of an existing thoracic vertebral body tethering construct, including its instrumentation, during spine surgery. Compare 22838 office and facility rates across CMS payment localities in Rhode Island.
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 22838 in Rhode Island?
Rhode Island 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
$1705.57
1 of 1 localities have a supported rate.
Payment area: Rhode Island
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 22838: Thoracic vertebral tether revision or removal
Reports revision, replacement, or removal of an existing thoracic vertebral body tethering construct, including its instrumentation, during spine surgery.
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.
CMS billing rules for 22838
- 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 is paid only with documentation of medical necessity.
- Co-surgeons
- Co-surgeons permitted.
- Team surgery
- Team surgery paid only with supporting documentation.
Where the value comes from
- Work RVU35.10 · 70%
- Practice expense (office) RVU11.57 · 23%
- Malpractice RVU3.75 · 7%
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.
22838 compared with similar codes
Office rates for Rhode Island, from the same CMS release.
No office rate
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.
No office rate
22855 applies to removal of anterior spinal instrumentation. 22838 is specific to revision, replacement, or removal of thoracic vertebral body tethering.
Compare 22838 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
Rhode Island →
Office / nonfacility
Unavailable
Facility
$1705.57
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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 22838 in Rhode Island.
PPRRVU2026_Oct_nonQPP.csv
2,111
- Code
- 22838
- Physician work
- 35.10
- Practice expense
- 11.57
- Malpractice
- 3.75
GPCI2026.csv
92
- Locality
- Rhode Island
- Physician work
- 1.019
- Practice expense
- 1.033
- Malpractice
- 0.892
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 35.10 | × 1.019 | 35.7669 |
| Practice expense | 11.57 | × 1.033 | 11.9518 |
| Malpractice | 3.75 | × 0.892 | 3.3450 |
| Total RVUs | 51.0637 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Rhode Island$1705.57
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 35.1 | 1.019 |
| Practice expense | 11.57 | 1.033 |
| Malpractice | 3.75 | 0.892 |
(35.1 × 1.019 + 11.57 × 1.033 + 3.75 × 0.892) × $33.4009 = $1705.57
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.
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 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.
2,10822830,,Exploration of spinal fusion,A,,10.94,9.42,NA,9.42,,3.34,23.70,23.70,0,090,0.10,0.69,0.21,2,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,10922836,,Ant thrc vrt body tethrg <7,A,,31.20,16.33,NA,16.33,,6.64,54.17,54.17,0,090,0.10,0.69,0.21,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11022837,,Ant thrc vrt body tethrg 8+,A,,34.61,11.46,NA,11.46,,3.69,49.76,49.76,0,090,0.10,0.69,0.21,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11122838,,Rev rplc/rmv thrc vrt tethrg,A,,35.10,11.57,NA,11.57,,3.75,50.42,50.42,0,090,0.10,0.69,0.21,2,0,0,2,1,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11222840,,Insert spine fixation device,A,,12.21,4.04,NA,4.04,,3.76,20.01,20.01,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11322841,,Insert spine fixation device,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
2,11422842,,Insert spine fixation device,A,,12.25,4.10,NA,4.10,,4.01,20.36,20.36,0,ZZZ,0.00,0.00,0.00,0,0,2,2,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336
9510312,TN,35,TENNESSEE,1.000,0.909,0.537