CPT 22212Surgery

Incis 1 vertebral seg thorac

CPT code 22212 covers a surgical procedure where a spine surgeon cuts and reshapes one segment of the thoracic spine (mid-back) to correct deformity or abnormal curvature. This is an add-on code used when additional vertebral segments beyond the first are treated during the same operative session.

Showing rates for

National Average

Base Medicare rate

$1,498.61

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

20.99

PE RVU (NF)

19.11

MP RVU

6.23

Total RVU

46.33

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document each additional vertebral segment separately in operative report with specific anatomical levels (e.g., T6, T7, T8) and type of osteotomy performed at each level
Impact: Proper documentation supports billing multiple units of 22212; each additional segment adds $1498.61 to case reimbursement
Always bill 22212 with appropriate primary osteotomy code (22206, 22207, or 22208); 22212 cannot be billed alone as it is an add-on code
Impact: Failure to bill with primary code results in automatic denial; correct pairing ensures full reimbursement of $1498.61 per additional segment
Report 22212 for each additional thoracic segment beyond the first; if three thoracic segments undergo osteotomy, bill primary code once and 22212 twice
Impact: Correct unit reporting: 3-level thoracic osteotomy generates approximately $4495.83 in additional reimbursement (2 units of 22212)
Verify pre-authorization requirements with commercial payers as multi-level thoracic osteotomies often require prior approval and peer review
Impact: Prevents denials that delay payment for high-value procedures; avoiding retrospective denials protects $1498.61+ per segment
Code to the exact anatomical region; do not use 22212 for lumbar or cervical segments as different add-on codes apply (22216 for lumbar, 22226 for cervical)
Impact: Using incorrect regional code triggers denials and delays; correct anatomical coding ensures clean claims and timely payment
Include diagnosis codes documenting medical necessity for multi-level osteotomy such as M41.46 (neuromuscular scoliosis, thoracic), M40.204 (unspecified kyphosis, thoracic), or S22.059A (wedge compression fracture)

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 22212 in 2025?

The 2025 Medicare national average reimbursement for CPT 22212 is $1,498.61 for both facility and non-facility settings. This rate is based on 46.33 total RVUs (20.99 work RVU + 19.11 PE RVU + 6.23 MP RVU) multiplied by the 2025 conversion factor of $32.3465.

How many times can you bill CPT code 22212 for a single surgery?

You can bill 22212 multiple times per operative session, with each unit representing one additional thoracic vertebral segment beyond the first. For example, if osteotomy is performed on three thoracic vertebrae, you would bill the primary code once and 22212 twice (for the second and third segments). Documentation must clearly identify each distinct level.

Can CPT 22212 be billed alone without a primary procedure code?

No, CPT 22212 is an add-on code and cannot be billed independently. It must always be reported in conjunction with a primary osteotomy code such as 22206, 22207, or 22208. Billing 22212 alone will result in automatic claim denial.

What documentation is required to support billing CPT 22212?

Documentation must include specific identification of each thoracic vertebral level treated (e.g., T5, T6, T7), the type of osteotomy performed at each level, medical necessity justification with imaging findings, intraoperative confirmation of levels, and detailed description of bone cuts. Pre-operative imaging showing degree of deformity and failed conservative treatment should also be available.

What is the difference between CPT 22212 and 22216?

CPT 22212 is specifically for additional thoracic vertebral segment osteotomy, while 22216 is for additional lumbar vertebral segment osteotomy. The codes differ by anatomical region: use 22212 for T1-T12 vertebrae and 22216 for L1-L5 vertebrae. Using the wrong regional code will result in claim denial.

Does CPT 22212 require modifier 51 for multiple procedure reduction?

No, CPT 22212 is exempt from modifier 51 requirements as it is designated as an add-on code by the AMA. Add-on codes are not subject to multiple procedure payment reductions and should not have modifier 51 appended. Each unit receives full reimbursement of $1,498.61.

What are common reasons for denial of CPT 22212 claims?

Common denials include lack of medical necessity documentation for multi-level osteotomy, insufficient operative report detail identifying each distinct vertebral level, bundling issues when billed incorrectly, billing without appropriate primary code, and using wrong anatomical region code (thoracic vs. lumbar vs. cervical). Appeals should address the specific denial reason with detailed clinical documentation.