CPT 22328Surgery

Treat each add spine fx

CPT code 22328 is an add-on code used when a surgeon treats each additional vertebral compression fracture beyond the first one during the same surgical session, typically using techniques like kyphoplasty or vertebroplasty.

Showing rates for

National Average

Base Medicare rate

$274.62

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

4.6

PE RVU (NF)

2.31

MP RVU

1.58

Total RVU

8.49

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

NCCI bundling edits

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Billing tips

Always bill 22328 with the appropriate primary code (22325 for vertebroplasty or 22510-22512 for percutaneous vertebral augmentation) - this add-on code cannot be billed alone
Impact: Billing without primary code results in 100% denial; proper pairing ensures $274.62 reimbursement per additional level
Document each treated vertebral level explicitly in the operative report with specific anatomical designations (e.g., T11, T12, L1) and fluoroscopic confirmation
Impact: Missing level-specific documentation is the #1 cause of downcoding; clear documentation supports payment for all levels treated
Report 22328 for each additional level beyond the first (e.g., for 3 levels total, bill primary code x1 + 22328 x2)
Impact: Correct unit reporting captures full reimbursement; treating 3 levels yields base code payment plus $549.24 (2 x $274.62) for add-on codes
Verify payer-specific policies on maximum number of vertebral levels covered per session, as some payers limit to 2-3 levels
Impact: Medicare typically covers up to 3 levels; exceeding payer limits may result in denial of $274.62 per additional level
Submit contemporaneous imaging reports (MRI, CT, or bone scan) demonstrating acute fractures at each treated level to establish medical necessity
Impact: Pre-operative imaging correlation reduces denial risk by approximately 40% and supports medical necessity during audits
Use modifier 59 judiciously only when treating non-contiguous levels or when payer edits inappropriately bundle the add-on code
Appropriate modifier 59 use can prevent bundling denials worth $274.62 per level; inappropriate use triggers audit flags

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22328 in 2025?

The 2025 Medicare national average reimbursement for CPT 22328 is $274.62 for both facility and non-facility settings, based on 8.49 total RVUs and the conversion factor of 32.3465.

Can CPT 22328 be billed alone or does it require a primary code?

CPT 22328 is an add-on code and cannot be billed alone. It must be reported with a primary vertebral augmentation code such as 22325, 22510, 22511, 22512, 22513, 22514, or 22515, which represent the first treated level.

How many times can I bill CPT 22328 for a single patient encounter?

You can bill 22328 for each additional vertebral level treated beyond the first level. For example, if treating 4 levels total, report the primary code once and 22328 three times. However, verify payer-specific limitations as some restrict coverage to 2-3 total levels per session.

What documentation is required to support billing CPT 22328?

Required documentation includes specific anatomical level identification for each vertebra treated, pre-operative imaging confirming fractures at each level, intra-operative fluoroscopic confirmation, level-specific procedural details in the operative report, and medical necessity justification for multi-level treatment.

Does CPT 22328 require modifier 51 for multiple procedures?

No, CPT 22328 is designated as an add-on code and is exempt from modifier 51. The code is already valued to reflect additional work and should not be reduced by multiple procedure payment reductions. However, modifier 59 may be appropriate for non-contiguous levels if payer edits require it.

What is the RVU value for CPT 22328 in 2025?

CPT 22328 has a total RVU of 8.49 in 2025, comprised of 4.6 work RVUs, 2.31 practice expense RVUs (both facility and non-facility), and 1.58 malpractice RVUs.

What are the most common denial reasons for CPT 22328?

The most common denials include billing without a primary procedure code, insufficient documentation of separate vertebral levels, lack of medical necessity justification for multi-level treatment, and exceeding payer maximum allowable levels per session (typically 2-3 levels).