Summary & Overview

CPT 22116: Vertebral Body Excision, Single Vertebra

CPT code 22116 identifies a targeted vertebral body excision in which portions of the main body of a single vertebra are removed to treat a damaged or diseased area, explicitly excluding decompression of the spinal cord or nerve roots. This code captures a focused spinal surgical intervention distinct from decompressive or multilevel vertebral procedures and is relevant for surgical coding, billing accuracy, and clinical documentation across hospital and ambulatory surgical settings nationwide.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the procedure, typical sites of service, and which payers commonly reimburse the service. The publication outlines benchmarks and billing considerations tied to this procedure, clarifies service classification, and highlights policy and coding nuances that affect claim adjudication.

This summary serves clinicians, coding professionals, and policy stakeholders seeking a clear, national-level overview of CPT code 22116, its clinical role, and the payer landscape relevant to surgical management of isolated vertebral body pathology.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 22116spine surgeryvertebral body excisionsurgical codinghospital outpatient surgeryambulatory surgery centerbilling guidanceprocedure coding

Billing Code Overview

CPT code 22116 describes a surgical procedure in which the provider excises portions of the main body of a single vertebra to remove a damaged or diseased area contained within that bone. The procedure specifically does not include decompression of the spinal cord or nerve roots.

Service Type: Vertebral body resection (partial), single vertebra without spinal cord or nerve root decompression

Typical Site of Service: Inpatient or outpatient hospital surgical setting or ambulatory surgery center, depending on clinical complexity and facility capabilities.

Clinical & Coding Specifications

Clinical Context

A 62-year-old patient presents with progressive focal back pain and localized vertebral body collapse after failed conservative management and confirmation of a solitary vertebral body lesion on CT and MRI. Pain is activity-limiting and refractory to analgesics and physical therapy. The spine surgeon evaluates imaging that demonstrates a contained pathology limited to a single vertebral body (for example, osteonecrosis, benign tumor, or isolated metastatic lesion) without evidence of neural element compression.

Preoperative workflow includes focused history and exam, imaging review (radiographs, CT, MRI), discussion of surgical goals (excision of the diseased portion of the vertebral body without decompression of the spinal cord or nerve roots), informed consent, medical clearance, and anesthesia evaluation. The patient is brought to the operating room, positioned, and the operative level is localized with fluoroscopy. The surgeon performs a partial vertebral body excision through an appropriate approach (anterior, posterior, or lateral) to remove the damaged/diseased bone while preserving neural structures; no direct decompression of spinal cord or nerve roots is performed. Hemostasis is achieved and wound closed. Postoperative care involves pain control, wound assessment, activity restrictions, and routine follow-up with imaging as indicated to assess structural integrity and healing.

Coding Specifications

Modifier	Description	When to Use
`22`	Increased procedural services

Taxonomy Code	Specialty	Notes
208W00000X	Orthopedic Spine Surgery	Orthopedic surgeons who specialize in spinal surgery commonly perform vertebral body excisions.
2084P0800X	Neurological Surgery (Spine)	Neurosurgeons with spine specialization perform complex vertebral body resections.
207RC0000X	Physical Medicine & Rehabilitation	PM&R physicians coordinate perioperative rehabilitation and postoperative functional recovery.
363A00000X	Anesthesiology	Anesthesiologists provide perioperative anesthesia and intraoperative management for spine procedures.

ICD-10 Code	Description	Clinical Relevance
`M84.58`	Pathological fracture, vertebra	Vertebral body excision may be indicated for a localized pathologic fracture causing structural compromise.
`M87.9`	Osteonecrosis, unspecified	Focal vertebral osteonecrosis confined to a single vertebral body can prompt excision of the diseased bone.
`C79.51`	Secondary malignant neoplasm of bone, vertebrae	Solitary metastatic lesion to a vertebral body may be treated with excision when localized and not causing neural compression.
`D16.6`	Benign neoplasm of vertebral column	Benign tumors confined to the vertebral body (e.g., hemangioma, osteoid osteoma) may be excised using this procedure.
`M48.56`	Fracture, nonunion, cervical region (instability)	Nonunion or collapse localized to a single vertebral body leading to pain and instability may require excision and reconstruction.
`M51.26`	Other intervertebral disc displacement, lumbar region	Included when disc disease coexists and surgical planning focuses on vertebral body pathology without neural decompression.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`22110`	Excision of portions of a single vertebral body, cervical, thoracic or lumbar; partial corpectomy, first vertebral body	May be used for partial corpectomy at a different anatomic level or when documentation supports this specific descriptor relative to `22116`.
`22551`	Arthrodesis, anterior interbody, including minimal discectomy to prepare interspace (other codes exist); lumbar	May be performed when stabilization with fusion is required after vertebral body excision.
`22845`	Anterior instrumentation; 2 to 3 vertebral segments	Instrumentation codes are used when internal fixation is placed in conjunction with vertebral body excision for stabilization.
`22851`	Application of intervertebral biomechanical device(s) (e.g., cage, spacer)	Used when an interbody device is placed to reconstruct vertebral height or support after excision.
`63267`	Laminectomy for excision or drainage of large intradural tumor, thoracic or lumbar	Different procedure class — listed when tumor resection involves intradural components; contrasts with `22116` which does not decompress neural elements.
`20930`	Allograft, morselized or placement of osteopromotive material	May be billed when bone graft or graft substitutes are used to reconstruct the vertebral body defect.

OpenPayer