CPT 22326Surgery

Treat neck spine fracture

CPT code 22326 covers the treatment of a fracture in the cervical spine (neck) using open surgical techniques to stabilize the vertebrae. This procedure involves direct manipulation and fixation of broken neck bones without using instrumentation like screws or plates.

Showing rates for

National Average

Base Medicare rate

$1,495.38

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

20.84

PE RVU (NF)

18.04

MP RVU

7.35

Total RVU

46.23

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

NCCI bundling edits

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Billing tips

Document the specific cervical level(s) treated and clearly state 'without instrumentation' to differentiate from higher-RVU instrumented fusion codes
Impact: Prevents downcoding to non-operative fracture care codes (worth $600+ difference) and supports medical necessity
When bone graft is harvested from a separate site, bill separately with +20936 (structural autograft) or +20937 (morselized autograft) as these are add-on codes not bundled with 22326
Impact: Additional $300-500 in reimbursement for graft harvesting that is otherwise lost if not separately coded
For bilateral or multiple-level fracture treatment during same session, append modifier 22 with detailed documentation of increased work rather than billing 22326 multiple times
Impact: Modifier 22 can increase payment 20-50% ($299-$748 additional) versus risk of denial for duplicate billing
Verify facility versus non-facility status with payer before billing; both rates are identical at $1495.38 for 22326, but documentation requirements may differ
Impact: Ensures correct place of service code and prevents technical denials; unusual for identical facility/non-facility rates
Link appropriate ICD-10 trauma codes (S12.xxx series) with 7th character for initial encounter (A) to establish acute fracture treatment medical necessity
Impact: Proper diagnosis coding prevents medical necessity denials and supports the acute traumatic nature of the procedure
Submit operative report with claim for high-dollar procedures rather than waiting for payer request; include fracture pattern description, reduction technique, and reason instrumentation was not used

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22326 in 2025?

The 2025 Medicare national average reimbursement for CPT 22326 is $1495.38 for both facility and non-facility settings, based on 46.23 total RVUs and the 2025 conversion factor of $32.3465. Local Medicare Administrative Contractors (MACs) may have slight geographic variations based on locality adjustments.

How does CPT 22326 differ from instrumented cervical fusion codes?

CPT 22326 specifically describes open treatment of cervical spine fracture WITHOUT instrumentation (no screws, plates, rods, or cages). If instrumentation is used, the appropriate code would be from the arthrodesis series (22551-22554 for anterior, 22590-22600 for posterior) with separate instrumentation codes (22842, 22845, 22846). The operative note must clearly document that no hardware was placed to support 22326.

Can CPT 22326 be billed multiple times for multiple cervical levels?

No, CPT 22326 is not a per-level code and should only be reported once per operative session regardless of the number of cervical levels treated. If the procedure involves multiple levels or is significantly more complex than typical, append modifier 22 (Increased Procedural Services) with documentation justifying the additional work rather than billing the code multiple times.

What modifiers are most commonly used with CPT 22326?

The most common modifiers for 22326 are: modifier 22 for increased procedural complexity when treating multiple levels or severely comminuted fractures; modifier 62 for co-surgeons when neurosurgeon and orthopedic surgeon work together; modifier 80/AS for surgical assistants; and modifier 78 for unplanned return to OR during the global period for complications.

What diagnosis codes support medical necessity for CPT 22326?

CPT 22326 is supported by ICD-10 codes from the S12 series (fracture of cervical vertebra), including S12.0-S12.9 with appropriate 7th character 'A' for initial encounter. Common codes include S12.000A (unspecified displaced fracture of first cervical vertebra), S12.100A (unspecified displaced fracture of second cervical vertebra), and other specific cervical fracture codes. Traumatic mechanism codes (V codes) should also be included.

Can bone graft harvesting be billed separately with CPT 22326?

Yes, autograft bone harvesting from a separate site can be billed separately using add-on codes +20936 (structural autograft for spine surgery per segment) or +20937 (morselized autograft for spine surgery). These are not bundled with 22326. However, local bone graft obtained from the surgical site itself is included in 22326 and cannot be billed separately. Allograft materials may be billed separately depending on payer policy.

What is the global period for CPT 22326 and what services are included?

CPT 22326 has a 90-day global period, meaning all routine pre-operative, intraoperative, and post-operative care within 90 days of surgery is included in the reimbursement. This includes post-op visits, wound care, and removal of hardware if any was placed. Separate E/M services during this period require modifier 24 (unrelated) or 25 (significant, separately identifiable) with clear documentation of the distinct service. Complications requiring return to OR use modifier 78.