Summary & Overview
CPT 0790T: Revision or Removal of Thoracolumbar/Lumbar Vertebral Body Tethering
CPT code 0790T covers revision, replacement, or removal of thoracolumbar or lumbar vertebral body tethering — a surgical intervention that uses screws and a flexible cable to treat spinal curvature from scoliosis. As emerging tethering techniques expand, this code captures corrective procedures that address hardware failure, progression of curvature, or complications from initial tethering. Nationally, such procedures are notable for their specialized surgical workflow, potential use of thoracoscopy, and implications for payer coverage policies and facility planning.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, typical sites of service, and the clinical context for revisional tethering procedures. The publication presents benchmarks and utilization context, highlights relevant policy and coverage considerations for major payers, and summarizes clinical factors that influence coding and billing for these spinal surgical services. Data not available in the input for certain elements (such as associated taxonomies, specific ICD-10 pairings, and related codes) are noted as unavailable and omitted from detailed tables.
Billing Code Overview
CPT code 0790T describes a procedure to revise, replace, or remove thoracolumbar or lumbar vertebral body tethering. The technique uses screws and a flexible cable to address spinal curvature caused by scoliosis and may be performed using thoracoscopy.
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Service type: Surgical revision or removal of spinal vertebral body tethering
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Typical site of service: Inpatient or outpatient surgical setting, including operating room with possible thoracoscopic approach
Clinical & Coding Specifications
Clinical Context
A 14-year-old adolescent with progressive thoracolumbar idiopathic scoliosis presents with a double major curve and documented growth remaining. The patient underwent prior vertebral body tethering (VBT) three years earlier using pedicle screws and a flexible tether. Over the last 12 months, radiographs show tether failure and loss of correction with increasing Cobb angle and pain. The surgeon schedules a revision procedure to revise, replace, or remove the thoracolumbar/lumbar vertebral body tethering construct. Preoperative workflow includes standing full-spine radiographs, CT or EOS imaging to assess hardware position, routine laboratory testing, and anesthesia clearance. Intraoperative workflow typically involves patient positioning (prone or lateral depending on approach), exposure of the previous instrumentation, removal or revision of screws and tether, potential partial or complete hardware exchange, and optional thoracoscopic assistance if a thoracic approach is required. Postoperative care includes inpatient monitoring for neurologic status and pain control, early mobilization with brace as indicated, and scheduled radiographic follow-up to evaluate alignment and hardware integrity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the procedure requires substantially greater work than typical and documentation supports increased effort, complexity, or operative time. |