CPT 22818Surgery

Kyphectomy 1-2 segments

CPT code 22818 covers a surgical procedure to remove or correct an abnormal forward curvature (kyphosis) of the spine, involving 1-2 spinal segments. This complex spinal reconstruction procedure is typically performed to treat severe spinal deformities that cause pain, neurological problems, or impaired function.

Showing rates for

National Average

Base Medicare rate

$2,098.64

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

34.33

PE RVU (NF)

23.53

MP RVU

7.02

Total RVU

64.88

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

NCCI bundling edits

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Billing tips

Always bill instrumentation codes separately (22840-22844 for posterior instrumentation, 22845-22847 for anterior) as these are not bundled with 22818
Impact: Additional $1,500-$4,000+ reimbursement depending on number of levels instrumented and approach used
Bill arthrodesis codes (22800-22802) separately when fusion is performed in conjunction with kyphectomy, which is standard practice
Impact: Additional $800-$1,500 reimbursement per spinal region fused
Document total operative time, estimated blood loss, specific anatomical levels treated, and degree of angular correction achieved to support medical necessity
Impact: Prevents denials and supports modifier 22 claims which can increase reimbursement by $400-$1,000
For congenital kyphosis cases, ensure diagnosis code specifies congenital etiology (Q76.4xx series) rather than acquired deformity to support medical necessity in younger patients
Impact: Reduces denial risk and pre-authorization delays, preventing payment delays of 30-90 days
Bill neuromonitoring (95940-95941) separately when used, as this is standard of care for kyphectomy and separately reimbursable
Impact: Additional $200-$500 per case when appropriately documented by qualified technologist
When performing kyphectomy with vertebral column resection, consider whether 22849 should be used instead, as it covers more extensive resections
Impact: Code 22849 has significantly higher RVUs and reimbursement; ensures accurate coding for work performed

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22818 in 2025?

The 2025 Medicare national average reimbursement for CPT 22818 is $2098.64 for both facility and non-facility settings, based on 64.88 total RVUs and a conversion factor of 32.3465.

Can CPT 22818 be billed with instrumentation codes?

Yes, CPT 22818 should be billed separately from spinal instrumentation codes (22840-22847). Instrumentation is not bundled with kyphectomy and represents distinct additional work that is separately reimbursable.

What is the difference between CPT 22818 and 22819?

CPT 22818 covers kyphectomy of 1-2 segments, while CPT 22819 covers 3 or more segments. The number of vertebral segments excised during the procedure determines which code to use, with 22819 representing more extensive surgery.

Does CPT 22818 include the fusion procedure?

No, CPT 22818 covers only the kyphectomy (vertebral excision) itself. Arthrodesis/fusion procedures must be coded separately using codes 22800-22802, as fusion is typically performed but represents distinct additional work.

What documentation is required to bill CPT 22818?

Required documentation includes specific vertebral levels treated, number of segments (1-2), surgical approach, extent of resection, degree of deformity corrected, medical necessity justification, and separate documentation of any instrumentation or fusion performed concurrently.

Is pre-authorization required for CPT 22818?

Most commercial payers and Medicare Advantage plans require pre-authorization for CPT 22818 due to its complex nature and high cost. Requirements vary by payer, but typically need imaging, clinical notes, and demonstration of medical necessity or failed conservative treatment.

What are the most common denial reasons for CPT 22818?

Common denials include lack of medical necessity documentation, insufficient evidence of failed conservative treatment, missing pre-authorization, incorrect bundling with fusion or instrumentation codes, and inadequate documentation of the specific number of segments treated.