Billing code 22836: Vertebral tetheringMedicare rate & RVUs in Texas
Reports anterior thoracic vertebral body tethering across fewer than seven vertebral segments, a growth-modulating operation most often used for selected scoliosis patients.
CMS doesn’t publish an office rate for 22836 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 22836 covers
An orthopedic spine surgeon places anchors in thoracic vertebral bodies and connects them with a flexible tether to guide spinal growth and address scoliosis. The operation is generally considered for skeletally immature patients when continued growth can help correct the curve. Thoracoscopic access may be used, but the code includes that work when performed. The service is distinct from rigid spinal fixation or fusion instrumentation.
Select this code by the documented extent of tethering: it describes fewer than seven vertebral segments. The operative report should identify the thoracic levels treated and the tethering performed; do not select it solely from the diagnosis or approach. This major surgery 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 midline spinal procedure. Assistant-at-surgery payment requires documented medical necessity; co-surgeons are permitted, and team-surgery payment 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 22836 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 | $1,817.76 |
| Beaumont | Unavailable | $1,744.49 |
| Brazoria | Unavailable | $1,763.96 |
| Dallas | Unavailable | $1,785.03 |
| Fort Worth | Unavailable | $1,782.46 |
| Galveston | Unavailable | $1,775.70 |
| Houston | Unavailable | $1,897.24 |
| Rest Of Texas | Unavailable | $1,760.00 |
How the 22836 rate is calculated
Each of 22836’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 · 22836
RVUs × geographic indexes × conversion factor
Work31.20
31.20 RVUs× 1.000 GPCI
Practice expense16.33
16.33 RVUs× 1.000 GPCI
Malpractice6.64
6.64 RVUs× 1.000 GPCI
Adjusted RVUs
54.1700
Conversion factor
$33.4009
Medicare rate
$1,809.33
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 22836
22836 has a 90-day global period: related visits in that window are included in the surgery payment.
CMS payment indicators · 22836
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 · 22836
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
22836 without 51 · national facility
$1,809.33
Vertebral tethering
22836-51 · Second procedure: 50%
$904.67
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%).
22836 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 22837Vertebral tethering
- Both codes describe anterior thoracic vertebral body tethering. Select 22836 for fewer than seven segments and 22837 for the larger extent.
- 22838Tether revision
- 22838 addresses revision, replacement, or removal of thoracic vertebral tethering; 22836 reports the tethering operation itself.
- 22845Anterior fixation
- 22845 describes anterior spinal instrumentation, a rigid fixation construct. Code 22836 describes flexible anterior thoracic tethering intended to guide growth.
22836 billing questions
How do I distinguish this code from 22837?
Choose based on the documented number of vertebral segments tethered. Code 22836 is for fewer than seven segments; 22837 describes the larger extent.
Does this code include thoracoscopy?
Yes. Thoracoscopic access, when performed for the tethering procedure, is included in the service.
Can modifier 50 be reported?
No. Modifier 50 is inappropriate for this midline spinal procedure.
What documentation supports the segment selection?
The operative report should identify the thoracic vertebral levels treated and document the tethering performed, supporting the segment count reported.
When is assistant-at-surgery payment supported?
Payment for an assistant at surgery requires documentation of medical necessity. Co-surgeons are permitted, while team-surgery payment requires supporting documentation.
How does the 90-day global period affect postoperative visits?
The global period 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 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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