Summary & Overview
CPT 22214: Lumbar Vertebral Osteotomy, Posterior/Posterolateral Approach
CPT code 22214 represents a surgical spinal osteotomy of a single lumbar vertebra performed via a posterior or posterolateral approach to realign the spine and correct deformity. This code is used for definitive reconstructive procedures addressing structural spinal deformities and has implications for hospital inpatient and ambulatory surgical center case mix, resource utilization, and clinical documentation standards. Nationally, accurate use of CPT code 22214 affects surgical quality reporting, payer coverage determinations, and cost tracking for complex spine care.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, typical sites of service, common modifier usage (listed separately), and the types of benchmarks payers commonly report for complex spinal procedures. The publication summarizes policy considerations relevant to prior authorization, inpatient versus outpatient classification, and documentation elements that support medical necessity for osteotomy procedures.
This report is intended to inform billing specialists, coders, clinical administrators, and policy analysts about the clinical definition of CPT code 22214, typical care settings, and the payer landscape impacting reimbursement and authorization workflows. Data not available in the input.
Billing Code Overview
CPT code 22214 describes an osteotomy of a lumbar vertebra performed via a posterior or posterolateral approach. The procedure involves a bony incision of one lumbar vertebra to realign the spine and correct spinal deformities.
Service type: Surgical — spinal osteotomy for deformity correction
Typical site of service: Hospital inpatient or ambulatory surgical center, posterior lumbar spine operative setting
Clinical & Coding Specifications
Clinical Context
A 56-year-old patient with progressive thoracolumbar kyphosis and symptomatic sagittal imbalance presents with chronic low back pain, neurogenic claudication, and progressive deformity after failed conservative care. Imaging demonstrates a rigid lumbar deformity with deforming coronal and sagittal malalignment centered at L3–L4 with facet arthropathy and multilevel degenerative disc disease. The surgical team schedules a posterior lumbar vertebral osteotomy (CPT code 22214) to correct alignment. The procedure is performed in an operating room in an inpatient or ambulatory surgical center setting depending on comorbidity and expected postoperative monitoring needs. Preoperative workflow includes history and physical, informed consent, templating with standing full-spine radiographs and CT for osteotomy planning, anesthesia evaluation, and perioperative antibiotics. Intraoperative workflow includes prone positioning, posterior midline or posterolateral exposure, localization of the targeted lumbar vertebra, performance of the bony osteotomy to permit realignment, supplemental posterior instrumentation (pedicle screws and rods) and fusion as indicated, hemostasis, and layered wound closure. Postoperative workflow includes routine recovery unit monitoring, neurologic checks, pain management, DVT prophylaxis, postoperative imaging to document correction, and inpatient rehabilitation or discharge planning based on recovery. Typical monitoring and documentation include operative note detailing levels, approach, estimated blood loss, implants, any intraoperative complications, and precise justification for the osteotomy level and technique.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|