Billing code 22208: Spinal osteotomyMedicare rate & RVUs in Texas
Reports an additional vertebral segment treated with a three-column spinal osteotomy during posterior or posterolateral surgery for rigid spinal deformity.
CMS doesn’t publish an office rate for 22208 in Texas.
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 22208 covers
A three-column osteotomy removes bone through the front, middle, and back columns of the spine to help correct a rigid deformity, such as fixed kyphosis or scoliosis. Spine surgeons typically perform the procedure through a posterior or posterolateral approach during complex reconstructive surgery. Code 22208 represents an additional vertebral segment treated with this osteotomy, beyond the segment represented by the primary procedure.
Report 22208 only with an appropriate primary three-column osteotomy code, such as 22206 for a thoracic segment or 22207 for a lumbar segment. The operative report should identify the spinal levels treated and document the additional osteotomy work; the number of fusion levels alone does not establish the number of osteotomy segments. CMS classifies 22208 as an add-on code, so it is billed with a primary procedure and paid within that procedure’s global period.
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 22208 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $522.69 |
| Beaumont | Unavailable | $510.89 |
| Brazoria | Unavailable | $506.11 |
| Dallas | Unavailable | $515.30 |
| Fort Worth | Unavailable | $515.62 |
| Galveston | Unavailable | $511.46 |
| Houston | Unavailable | $570.03 |
| Rest Of Texas | Unavailable | $512.27 |
How the 22208 rate is calculated
Each of 22208’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 · 22208
RVUs × geographic indexes × conversion factor
Work9.42
9.42 RVUs× 1.000 GPCI
Practice expense3.19
3.19 RVUs× 1.000 GPCI
Malpractice3.20
3.20 RVUs× 1.000 GPCI
Adjusted RVUs
15.8100
Conversion factor
$33.4009
Medicare rate
$528.07
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 22208
The CMS indicators that decide how 22208 is paid alongside other services.
CMS payment indicators · 22208
Spinal osteotomy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 2 | Paid. |
| Co-surgeons (62) | 1 | Permitted with supporting documentation. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 80 · payment effect
With and without the modifier
22208 without 80 · national facility
$528.07
Spinal osteotomy
22208-80 · Assistant: 16%
$84.49
A physician assistant at surgery is paid 16% of the surgeon’s fee schedule amount.
22208 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 22206Spinal osteotomy
- 22206 reports the primary thoracic three-column osteotomy segment. Use 22208 for each additional segment treated with that technique.
- 22207Spinal osteotomy
- 22207 reports the primary lumbar three-column osteotomy segment. 22208 represents an additional segment, not the primary lumbar work.
- 22216Spinal osteotomy
- 22216 is an additional-segment code for another posterior or posterolateral osteotomy family; 22208 is specific to additional three-column osteotomy work.
- 22214Spine osteotomy
- 22214 represents a single lumbar segment in the posterior or posterolateral osteotomy family. 22208 is for an additional segment treated with a three-column osteotomy.
22208 billing questions
Can 22208 be billed by itself?
No. It is an add-on code and must be reported with an eligible primary three-column osteotomy, such as 22206 or 22207.
How is 22208 different from 22207?
22207 represents the primary three-column osteotomy at a lumbar segment. Use 22208 for an additional segment treated with the three-column technique.
Does the number of fused levels determine the units?
No. Document the vertebral segments where the additional three-column osteotomy was performed; fusion levels alone do not establish osteotomy units.
What documentation supports reporting 22208?
The operative report should identify the additional vertebral level and describe the three-column osteotomy performed there, along with the approach and primary procedure.
How does 22208 differ from 22216?
Both represent additional osteotomy segments, but 22208 belongs to the three-column osteotomy family. Code 22216 is used with a different posterior or posterolateral osteotomy family.
How does CMS treat payment for this add-on code?
CMS identifies 22208 as payable only with a primary procedure and within that procedure’s 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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