Spine and Trauma CPT Finder 2026 values

How several codes pay together

• The highest-valued primary code pays 100%. Every other primary code pays 50%. Add-on codes always pay 100%. Most missed money is in add-ons.
• wRVU totals here give full credit for every code. Some employers apply the same 50% rule to wRVUs; check your contract.
• For 2026 CMS cut work RVUs for nearly all procedures by 2.5%; visit codes were spared. A contract pinned to an older schedule year will show slightly higher procedure values.

Count the right unit

• Fusion: interspaces. Laminectomy (63045-63048): levels. Laminotomy or discectomy: interspaces. Corpectomy: vertebrae. Cages: interspaces. Graft codes: once per operation.
• Posterior instrumentation by vertebrae spanned: 2 is 22840, 3-6 is 22842, 7-12 is 22843, 13 or more is 22844.
• Anterior instrumentation: 2-3 vertebrae is 22845, 4-7 is 22846, 8 or more is 22847.

Most often left off the charge sheet

• A cage code (22853) at every interspace, the instrumentation code, and every additional-level add-on.
• 63052/63053 for a real decompression at a TLIF or PLIF level.
• Navigation (61783), iliac crest graft (20937), marrow aspirate (20939), structural allograft (20931), pelvic fixation (22848).
• Fracture reduction (22325-22328) on top of a trauma fusion; open fracture debridement (11010-11012); syndesmosis fixation (27829); antibiotic cement (20700-20704).
• The visit where you decided to operate, with modifier 57.
• Fracture care codes for non-operative fractures (22310, 25605 and the like), clinic X-rays, tobacco counseling.

Never billable on their own

• Exposure and closure, fluoroscopy, a durotomy repaired during the index case, scar lysis (use modifier 22 instead), neuromonitoring by the operating surgeon.
• Hardware you remove and replace at the same levels.
• Local autograft and allograft chips under Medicare (20936, 20930).
• The operative note, and related rounds and clinic visits inside the global period (99024).
• Extra rods (kickstand, accessory, satellite), connectors, hooks, tethers and BMP. They support modifier 22 when the note gives the added time.
• A block you place yourself for post-operative pain (erector spinae block), cultures and specimens, the chest tube after your own thoracotomy.
• Braces you order or apply, dressings and dressing changes, drain placement and removal, and suture or staple removal after your own operation. An incisional vac (97607, 97608) is reportable under CPT but is under half a wRVU and many payers bundle it.
• Repair of a vessel or dural injury that happens during your own operation. A vascular surgeon called in bills their own repair.

Deformity and long constructs: what bills and what does not

• Bills: laminectomy at levels decompressed for stenosis (63047/63048); Schwab 2 osteotomies (22210-22216); PSO and VCR (22206-22208); every interbody and its cage; pelvic fixation; iliac crest or rib autograft through a separate incision; structural allograft; navigation when you register and navigate.
• Does not bill: Schwab 1 facet resection, extra rods, cross-links, tethers and ligament augmentation, cement around a screw, C-arm or an O-arm spin on its own, cell saver, neuromonitoring, BMP and allograft chips under Medicare.
• Closing your own incision is never billable, however it is done. Medicare's rule is that wound repair codes 12001-13153 may not be reported for closure of a surgical incision. A plastic surgeon who raises a muscle flap bills their own code.
• Cement injected into a vertebral body above the construct is a vertebroplasty (22510-22512), but payers often treat prophylactic use as investigational.

Op note lines that carry each code

• Posterolateral fusion (22612, 22614, 22633): "Posterolateral arthrodesis at L4-5: transverse processes and facets decorticated, graft placed." Name each interspace and the graft.
• Interbody (22630, 22633, 22558) and cage (22853): disc removed, endplates prepared, cage and graft placed, at each named interspace.
• Decompression with TLIF (63052): "Separate from the facetectomy for cage access, laminectomy of L4 with bilateral medial facetectomies and foraminotomies to decompress the L5 roots."
• Instrumentation (22840-22844, 22848): list every vertebra that holds a screw or hook, and the iliac or S2AI screws.
• Navigation (61783): your planning from the images, the reference frame, the image acquisition, registration, the accuracy check, and that each screw was navigated.
• Microscope (69990): microsurgical instruments used for microdissection under the microscope. "Draped and brought into the field" is not enough, and using it only to see does not count. Never with ACDF.
• Autograft (20937, 20938): "Through a separate fascial incision over the posterior iliac crest, cancellous graft harvested."
• Osteotomy (22210-22216, 22206-22208): put the deformity diagnosis (kyphosis, flatback) in the operative report itself; say the bone was removed to mobilize the spine for realignment, not for decompression; give the degrees of correction; name each segment.
• Fracture (22325-22328): the decompression, fragments removed, and how the spine was realigned. A laminectomy at the fractured vertebra is included.
• Corpectomy: the fraction of the body removed (half cervical, one third thoracic or lumbar) and the discs removed above and below.
• Modifier 22: the extra minutes and the cause ("dense epidural scar from prior laminectomy added 75 minutes").
• Assistant: the assistant's name, credentials and the specific steps they performed; at a hospital with residents, that no qualified resident was available. Co-surgeon: each surgeon dictates their own note for their part and why two surgeons were needed.
• Shared visit with your PA or NP: an attestation specific to that patient, stating what you personally did and the plan you made or approved.
• Consult or clinic note before surgery: "Decision for surgery made today" (modifier 57).

Call

• There is no code that pays for being on call. After-hours and on-call codes (99026, 99027, 99050-99060) carry no Medicare value, are not meant for hospital services, and most commercial plans do not pay them.
• Call income is the hospital stipend plus billing every encounter: the consult with modifier 57, fracture care, reductions, wound repairs, critical care, and phone consults that do not lead to a visit.
• Published stipend benchmarks vary widely: one contract survey put orthopedic trauma call at a mean of $2,710 a day, and a physician-reported survey put the orthopedic median at $1,075 a day with about half of call-takers paid at all. Use those as a starting point for your own contract.

Ways to collect more, inside the rules

• Dictate for the codes. Name "posterolateral arthrodesis" with the graft at each interspace, each level decompressed and what was removed, the vertebrae instrumented, any fracture reduction, navigation registration, and where graft came from and through which incision.
• Pick the fusion family by indication. Deformity codes are for correcting scoliosis or kyphosis. A long fusion for degenerative disease, fracture, tumor or infection is coded per level, and T10-S1 is 66.83 wRVU that way against 31.31 for 22802. Using either family for the wrong indication is miscoding.
• When staging is the right clinical plan, the second stage takes modifier 58 and pays in full instead of 50%.
• Operate with a partner as co-surgeons on big cases when each of you does a distinct part. Each bills modifier 62 and is paid 62.5%. Deformity, three-column osteotomy and corpectomy codes need both notes to say why two surgeons were required.
• A PA or NP you employ can bill as assistant at surgery (AS) on most spine and fracture codes.
• Bill the non-operative work: the decision visit with modifier 57, rounds on non-surgical admissions, fracture care for braced fractures, phone consults that do not lead to a visit, clinic X-rays, prolonged time.
• Reconcile every month: compare each op note against what was billed and what was paid, and appeal the denials. Send unlisted and modifier 22 claims with the note and a comparison code.
• Know your contract: the dollars per wRVU, whether secondary codes and modifier 22 earn full wRVU credit, and what call and trauma coverage pay.

Modifiers

22

Unusually hard case. State the extra time and the cause in the op note ("revision with dense scar, 90 extra minutes"). Often 20-30% more when accepted.

50

Bilateral.

51

Multiple procedures. Payers apply the 50% rule; most billing systems add it for you.

57

Decision for major surgery made at this visit, the day of or day before a 90-day procedure.

25

Separate visit on the day of an injection or other minor procedure.

24

Unrelated visit during a global period.

58

Staged, planned or more extensive procedure during the global. Pays in full and starts a new global.

78

Unplanned return to the OR for a complication during the global. Pays the intra-operative share.

79

Unrelated procedure during the global.

59 / XS

Distinct procedure at a separate level or site, when two codes would otherwise bundle.

62

Two surgeons each doing a distinct part of one code (ALIF with an access surgeon). Each is paid 62.5% and each dictates.

80 / 82 / AS

Assistant at surgery. A physician assistant surgeon is paid 16% of the fee; a PA or NP billing AS gets 85% of that. 82 when no qualified resident was available.

54 / 55

Surgical care only, or post-operative care only (you reduce a fracture and someone else follows it).

93 / 95

Audio-only or video telehealth.

Medicare and commercial payers differ

• Consult codes 99242-99255 and audio-only codes 98008-98015: commercial only. Medicare takes office, hospital or ED visit codes instead.
• Microscope 69990: Medicare pays it only with a short list of codes that includes 63081-63308.
• Pelvic ring 27215-27218: Medicare wants G0412-G0415.
• Endoscopic 62380 and unlisted codes are priced by each payer. Send the op note and name a comparison code.

What separates 99204/99214 from 99205/99215

• Level is set by two of three: problems, data, risk. Or by total time on the date: 60 minutes new, 40 established.
• Moderate (99204, 99214): a chronic problem that is worsening or not at goal, a new problem with uncertain prognosis, or an acute complicated injury. Risk is prescription management or a decision for elective major surgery without risk factors.
• High (99205, 99215): a problem that threatens life or bodily function, or severe progression (progressive myelopathy, cauda equina, unstable spine). Risk is a decision for elective major surgery with patient or procedure risk factors, or for emergency major surgery.
• Data, moderate: any three of outside notes reviewed, each test result reviewed, each test ordered; or your own interpretation of imaging; or a discussion with another treating clinician. High needs two of those three categories.