CPT 22310Surgery

Closed tx vert fx w/o manj

CPT code 22310 covers the non-surgical treatment of a broken vertebra (spinal bone) when the doctor does not need to physically move or manipulate the bone fragments back into position. This typically involves pain management, bracing, and monitoring the fracture as it heals naturally.

Showing rates for

National Average

Base Medicare rate

$310.53

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

3.45

PE RVU (NF)

5.38

MP RVU

0.77

Total RVU

9.6

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

NCCI bundling edits

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Billing tips

Always verify the fracture level and document whether it is the initial treatment or subsequent care, as this determines whether to use 22310 versus an E/M code for follow-up
Impact: Prevents estimated 30-40% denial rate for services billed as procedures when only evaluation was performed
Bill non-facility setting ($310.53) when providing treatment in a physician-owned clinic with your own equipment and staff, versus facility setting ($296.94) in hospital-owned locations
Impact: Ensures maximum reimbursement with $13.59 higher payment in appropriate non-facility settings
Document medical necessity for bracing separately and bill the orthotic device using appropriate L-codes in addition to 22310 for the treatment service
Impact: Captures additional $200-800 in reimbursement for bracing devices which are separately billable
When treating multiple vertebral levels on the same date, carefully review bundling rules; typically only one 22310 is billable unless treating entirely separate injuries with modifier 59
Impact: Prevents automatic denials and recoupments averaging $296-310 per incorrectly bundled code
Link appropriate ICD-10 codes specifying exact vertebral level, laterality, episode of care (initial vs subsequent), and fracture etiology (traumatic vs pathological)
Impact: Reduces denial rate by 25-35% through proper medical necessity demonstration
Submit treatment within 90 days of fracture occurrence and document why closed treatment is appropriate versus surgical intervention to support medical necessity
Prevents medical necessity denials which require costly peer-to-peer reviews and appeals

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22310 in 2025?

The 2025 Medicare national average reimbursement for CPT 22310 is $310.53 in non-facility settings and $296.94 in facility settings. The total RVU is 9.6 with a work RVU of 3.45, calculated using the 2025 conversion factor of 32.3465.

Can I bill an office visit and CPT 22310 on the same day?

Yes, but only if the E/M service is separately identifiable and significant beyond the typical evaluation included in 22310. You must append modifier 25 to the E/M code and document distinct work such as evaluation of unrelated conditions or extensive history/examination beyond what is needed for fracture treatment decision-making.

What is the difference between CPT 22310 and 22315?

CPT 22310 is for closed treatment of vertebral fracture WITHOUT manipulation, while 22315 is for closed treatment WITH manipulation or mobilization of the fracture fragments. Code 22315 requires documentation that the physician actively manipulated the spine to improve fracture alignment and carries higher reimbursement due to increased work.

How many times can I bill CPT 22310 for the same patient?

You can bill 22310 once per vertebral fracture episode. If the patient sustains a new fracture at a different level or has a new traumatic event during the 90-day global period, you may bill again with appropriate modifiers (76 for same physician, 77 for different physician, or 79 for unrelated procedure) and clear documentation of the new injury.

What diagnosis codes support medical necessity for CPT 22310?

Appropriate ICD-10 codes include S22.0- (fracture of thoracic vertebra), S32.0- (fracture of lumbar vertebra), M48.4- (fatigue fracture of vertebra), and M80.- (osteoporosis with current pathological fracture). Always specify the exact vertebral level, episode of care (initial encounter), and laterality when applicable.

Is CPT 22310 subject to a global surgical period?

Yes, CPT 22310 has a 90-day global surgical period. This means routine postoperative visits related to the fracture treatment during the 90 days following the procedure are included in the payment and cannot be billed separately. Only unrelated E/M services or complications requiring return to treatment can be billed with appropriate modifiers.

Can physical therapy assistants or chiropractors bill CPT 22310?

No, CPT 22310 requires a physician (MD or DO) within appropriate scope of practice, such as orthopedic surgery, neurosurgery, or physiatry. Physical therapists and chiropractors cannot bill this surgical code. Physician assistants and nurse practitioners may participate under appropriate physician supervision according to state regulations and payer policies.