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    OpenPayerBilling CodesFracture and/or Dislocation Procedures on the Spine (Vertebral Column)CPT cpt-22318-odontoid-fracture-open-fixation-no-graft
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    CPT 22318: Open Reduction and Internal Fixation of Odontoid Fracture

    Medicare pays $1630 on average nationally for this procedure.

    CPT code 22318 describes an open surgical procedure for treatment of a fracture or dislocation of the odontoid (the uppermost cervical vertebra) in which the surgeon makes a neck incision, achieves reduction to restore alignment, and places internal fixation hardware such as screws or wires to stabilize the odontoid during healing; this is an open reduction with internal fixation procedure typically performed in an operating room as spinal surgery.

    For related coverage guidance, see recent payer policy updates: Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM), Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®), Lumbar Microdiscectomy.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult who sustained acute cervical trauma after a fall or motor vehicle collision and presents with neck pain, limited range of motion, and possible neurologic symptoms. Imaging (CT and cervical spine radiographs, often supplemented with MRI) demonstrates a fracture or dislocation of the odontoid process (dens) of C2. After neurosurgical or spine-surgical evaluation, the patient is taken to the operating room for open reduction and internal fixation of the odontoid without bone grafting. The clinical workflow includes preoperative stabilization with a cervical collar, neurovascular and airway assessment, informed consent, anesthesia evaluation, open anterior or posterior cervical approach, reduction of the odontoid fracture/dislocation, placement of screws or wiring for internal fixation, intraoperative imaging to confirm alignment and hardware position, postoperative neurologic monitoring, pain control, application of external immobilization as indicated (rigid cervical collar or halo vest if required), and scheduled follow-up with serial imaging to assess healing.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    72040Radiologic examination, spine, single view, each additional view; cervical spinePreoperative and postoperative plain radiographs for initial assessment and follow-up after 22318.
    72100Radiologic examination, spine, cervical; 2 or 3 viewsStandard cervical spine x-rays obtained in the emergency department and during follow-up for patients undergoing 22318.
    72020Radiologic examination, spine, cervical; single viewSingle-view cervical radiograph that may be obtained during initial trauma evaluation prior to 22318.
    76000Fluoroscopic guidance; simple (eg, localization)Intraoperative fluoroscopic localization and imaging used during placement of screws/wires in 22318.
    21069Application of halo traction device (for craniofacial/upper cervical)External immobilization or halo-related procedures performed before or after fixation in unstable odontoid injuries; used when halo application is part of management adjunctive to 22318.

    Related Modifiers

    14 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    51Modifier –51 (Multiple Procedures) is used when the same provider performs multiple procedures in the same session to identify secondary, non‑exempt procedures and indicate payment reduction logic…- Use modifier -51 when the same provider performs multiple distinct procedures during the same patient encounter: report the highest‑valued procedure first (no modifier) and append -51 to…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    63Modifier‑63 is appended to surgical CPT codes (20000–69990) when a procedure is performed on a neonate or infant weighing ≤ 4 kg (about 8.8 lbs). The AMA/AAPC definition specifies this use and notes…- Use modifier -63 only for surgical procedures in the CPT 20000–69990 series performed on a neonate or infant who weighs ≤ 4 kg at the time of the procedure; it indicates increased complexity due to…
    66Modifier 66 (Surgical Team) is used when three or more surgeons act as primary surgeons on a single, highly complex procedure. The AMA defines it for use when a surgical team — often composed of…- Use modifier 66 when three or more surgeons act as primary surgeons working collaboratively as a surgical team on a single, highly complex or difficult procedure (for example organ…

    Showing 1–10 of 14

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    2084P0800X
    207RH0000X
    310400000X
    2471C1106X
    1835N1003X
    374T00000X
    2084V0102X

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 2

    10 rows

    PolicyPayerEffective Date
    Clinical Review Criteria Intraoperative Neurophysiological Monitoring (IONM)Kaiser Permanente2027-01-01
    Remote Electrical Neuromodulation for Migraines (i.e., Nerivio®)bcbsvermont2026-11-01
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Responsive Neurostimulation for Focal EpilepsyPremera Bluecross2026-10-14
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    Intraoperative MonitoringProvidence Health Plan2026-10-01
    High-Intensity Focused UltrasoundMass General Brigham Health Plan2026-10-01
    Vagal Nerve StimulationAmbetter Nevada2026-10-01

    Related Codes

    CPT-22310-VERTEBRAL-BODY-FRACTURE-CLOSED-TREATMENT-IMMOBILIZATION

    CPT 22310: Closed Treatment of Vertebral Body Fracture with Cast or Brace

    CPT-22315-CLOSED-REDUCTION-VERTEBRAL-BODY-FRACTURE-IMMOBILIZATION

    CPT 22315: Closed Reduction of Vertebral Body Fracture

    CPT-22319-ODONTOID-REPAIR-ANTERIOR-APPROACH-INTERNAL-FIXATION

    CPT 22319: Anterior Odontoid Fixation with Bone Graft

    CPT-22325-OPEN-REDUCTION-LUMBAR-VERTEBRA-FRACTURE-DISLOCATION

    CPT 22325: Open Reduction of Lumbar Vertebral Fracture/Dislocation

    CPT-22326-CERVICAL-VERTEBRA-FRACTURE-DISLOCATION-REPAIR-POSTERIOR-APPROACH

    CPT 22326: Repair of Cervical Vertebra Fracture or Dislocation

    CPT-22327-THORACIC-VERTEBRA-OPEN-REDUCTION-POSTERIOR

    CPT 22327: Open Reduction of Thoracic Vertebra Fracture

    CPT-22328-VERTEBRAL-FRACTURE-DISLOCATION-REPAIR

    CPT 22328: Vertebral Fracture or Dislocation Repair, Open Approach

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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