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    v1.0.30
    OpenPayerBilling CodesFracture and/or Dislocation Procedures on the Spine (Vertebral Column)CPT cpt-22319-odontoid-repair-anterior-approach-internal-fixation
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    CPT 22319: Anterior Odontoid Fixation with Bone Graft

    Medicare pays $1813 on average nationally for this procedure.

    CPT code 22319 describes anterior surgical repair of an odontoid (first cervical vertebra) fracture or dislocation using internal fixation and bone grafting; the service is an open cervical spine surgery (anterior approach) performed in an operating room and is classified as a procedural intervention for traumatic cervical spine injury.

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 45-year-old male presents to the emergency department after a high-speed motor vehicle collision with neck pain, limited neck motion, and point tenderness at the upper cervical spine. Initial cervical CT demonstrates a displaced odontoid (dens) fracture of the axis (C2) with instability. The surgical team elects an anterior odontoid screw fixation with bone grafting to restore alignment and stability.

    Preoperative workflow includes trauma evaluation, cervical spine CT and x-rays, neurosurgical consultation, informed consent emphasizing risks (infection, neurovascular injury, nonunion), crossmatch if indicated, and preoperative anesthesia assessment. Intraoperative workflow involves an anterior cervical approach in the operating room with fluoroscopic guidance, placement of one or more odontoid screws and autograft or allograft bone grafting for fusion, hemostasis, and incision closure. Postoperative management includes cervical immobilization, postoperative imaging to confirm hardware position, pain control, routine wound checks, and outpatient follow-up for fusion assessment and activity restrictions.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    22319Repair of fracture or dislocation of odontoid through anterior approach with internal fixation and bone graftingPrimary procedure for anterior odontoid repair (this code)
    63030Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy, single vertebral segment; cervicalMay be performed if posterior decompression is required in staged or combined procedures
    22630Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (cervical)Used when a posterior fusion or additional arthrodesis is required in conjunction with odontoid fixation
    20930Allograft, morselized, or placement of osteopromotive material, for spine surgeryUsed when allograft bone graft materials are used instead of autograft during fixation
    76000Fluoroscopic guidance for needle placement (eg, for spine)Intraoperative fluoroscopy is commonly used to guide screw placement during anterior odontoid fixation
    10120Incision and removal of foreign body, subcutaneous tissues; simple (for wound exploration or debridement)May be used for postoperative wound debridement if infection or hardware exposure occurs

    Related Modifiers

    12 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…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…

    Showing 1–10 of 12

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2084P0800X
    2086S0122X
    2084N0400X
    208000000X
    202C00000X
    3336M0003X
    2279H0200X
    246QM0706X

    Related ICD-10-CM Codes

    11 rows

    ICD-10-CM CodeDescription
    M48.02Spinal stenosis, cervical region
    M50.20Other cervical disc displacement, unspecified cervical region
    S06.0X0AConcussion without loss of consciousness, initial encounter
    S07.1XXACrushing injury of skull, initial encounter
    S12.100AUnspecified displaced fracture of second cervical vertebra, initial encounter for closed fracture
    S12.101AUnspecified nondisplaced fracture of second cervical vertebra, initial encounter for closed fracture
    S12.9XXAFracture of neck, unspecified, initial encounter
    S13.4XXASprain of ligaments of cervical spine, initial encounter
    S14.0XXAConcussion and edema of cervical spinal cord, initial encounter
    T14.8XXAOther injury of unspecified body region, initial encounter

    Showing 1–10 of 11

    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-22318-ODONTOID-FRACTURE-OPEN-FIXATION-NO-GRAFT

    CPT 22318: Open Reduction and Internal Fixation of Odontoid Fracture

    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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