CPT 22318Surgery

Treat odontoid fx w/o graft

CPT 22318 covers the surgical treatment of an odontoid fracture (broken bone at the top of the spine in the neck) without using a bone graft. This procedure stabilizes the second cervical vertebra after trauma or injury.

Showing rates for

National Average

Base Medicare rate

$1,635.12

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

22.72

PE RVU (NF)

18.92

MP RVU

8.91

Total RVU

50.55

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

NCCI bundling edits

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Billing tips

Document the specific approach (anterior vs posterior) and fixation method (transarticular screws, posterior wiring, screw-rod construct) in operative notes
Impact: Prevents denials for insufficient documentation; missing approach details can trigger $1635 claim rejection
Clearly state absence of bone graft material in operative report to distinguish from 22319 (with graft) which has different reimbursement
Impact: Prevents upcoding accusations or downcoding; 22319 reimburses differently and requires graft documentation
Capture all fluoroscopy/imaging with separate 77002 or 77003 codes when performed for intraoperative guidance
Impact: Additional $50-150 per imaging session; these are separately billable and commonly missed
Bill separately for any instrumentation/hardware using appropriate supply codes or implant pass-through billing
Impact: Hospital facility can recover $5000-15000 in hardware costs; surgeon billing unaffected but coordination prevents delays
For Medicare patients, verify LCD and NCD coverage for traumatic odontoid fractures before scheduling to avoid non-covered denials
Impact: Prevents entire $1635 payment denial; some MACs have specific traumatic vs pathologic fracture requirements
Submit claims with appropriate ICD-10 codes specifying fracture type (S12.110A-S12.111A for type II, S12.112A for type III) and initial encounter
Impact: Improves first-pass claim acceptance rate by 30-40%; incorrect diagnosis codes are top denial reason

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22318 in 2025?

The 2025 Medicare national average reimbursement for CPT 22318 is $1635.12 for both facility and non-facility settings, based on 50.55 total RVUs and a conversion factor of 32.3465.

What is the difference between CPT 22318 and 22319?

CPT 22318 is for odontoid fracture treatment WITHOUT bone graft, while 22319 includes bone graft placement. The absence or presence of graft material must be explicitly documented in the operative report to support the correct code selection.

Can CPT 22318 be billed with other cervical spine fusion codes?

Generally no, unless performed at anatomically distinct levels or through separate incisions. When billing together, modifier 59 or XS may be required with comprehensive documentation showing the procedures were distinct and not components of a single surgical approach.

What diagnosis codes support medical necessity for CPT 22318?

Primary diagnosis codes include S12.110A (displaced Type II odontoid fracture, initial encounter), S12.111A (nondisplaced Type II), and S12.112A (Type III odontoid fracture). Secondary codes may include associated spinal cord injury or mechanism of injury codes.

How many RVUs is CPT code 22318 worth in 2025?

CPT 22318 has 50.55 total RVUs in 2025, consisting of 22.72 work RVUs, 18.92 practice expense RVUs, and 8.91 malpractice RVUs for both facility and non-facility settings.

Is prior authorization required for CPT 22318?

Most commercial payers and Medicare Advantage plans require prior authorization for CPT 22318 due to its surgical nature and high cost. Traditional Medicare does not require prior authorization but does require medical necessity documentation. Verify payer-specific requirements before scheduling.

Can CPT 22318 be performed in an ambulatory surgery center?

While technically possible, CPT 22318 is typically performed in hospital inpatient settings due to the traumatic nature of odontoid fractures, need for ICU monitoring, and potential for spinal cord complications. ASC reimbursement rates and medical necessity criteria vary by payer and may not be covered.