2025 CPT code 22511
(Active) Effective Date: N/A Revision Date: N/A Surgery - Vertebral Procedures Musculoskeletal System Feed
Percutaneous vertebroplasty (includes bone biopsy if performed), one lumbosacral vertebral body, unilateral or bilateral injection; all imaging guidance included.
Modifiers may be appended to 22511 as clinically indicated (e.g., 51 for multiple procedures, 59 for distinct procedural service, 76 for repeat procedure).Always consult the NCCI edits and payer guidelines to ensure appropriate modifier use.
Medical necessity for percutaneous vertebroplasty is typically established when conservative management (e.g., pain medication, bracing) has failed to alleviate symptoms associated with a vertebral compression fracture.The fracture should be symptomatic and cause significant pain and disability. The procedure should be medically appropriate given the patient’s overall condition and life expectancy.
The physician or qualified healthcare professional is responsible for performing the percutaneous vertebroplasty under image guidance, including injection of bone cement and bone biopsy (if done). Pre-operative and post-operative care may be billed separately using appropriate EM codes.
In simple words: This code describes a minimally invasive procedure to repair a broken bone in the lower back (lumbosacral spine).A special cement is injected into the broken bone to strengthen it.This is done with the help of X-ray imaging.A small sample of bone may also be taken for testing.The cost of the X-rays is included in the procedure.
This CPT code encompasses percutaneous vertebroplasty of a single lumbosacral vertebral body.The procedure involves the injection of bone cement (typically methyl methacrylate) into the vertebral body under image guidance (fluoroscopy or CT scan) to stabilize a fractured vertebra.A bone biopsy may be included if performed.The code includes both unilateral and bilateral injections of the specified vertebral body. All necessary imaging guidance is bundled into this code.Additional vertebral bodies treated during the same session require the add-on code 22512.
Example 1: A 70-year-old female presents with severe back pain due to an osteoporotic compression fracture of L1.After conservative management fails, percutaneous vertebroplasty (22511) is performed to stabilize the fracture.Image guidance (fluoroscopy) was used to precisely place the cement., A 65-year-old male with metastatic cancer to the spine experiences debilitating pain due to compression fractures of L2 and L3.A percutaneous vertebroplasty is performed, using 22511 for L2 and 22512 for L3.Post-procedure, pain significantly reduces, and patient mobility improves., A 55-year-old female with osteoporosis sustains a compression fracture of L4.During the percutaneous vertebroplasty (22511), a bone biopsy is also performed to rule out other conditions.Results show consistent with osteoporotic fracture.
* Pre-operative diagnosis supporting medical necessity (e.g., imaging studies demonstrating vertebral compression fracture, patient history and physical examination findings).* Detailed operative report describing the procedure, including the number of vertebral bodies treated, location, approach (unilateral or bilateral), type of cement used, and biopsy (if performed).* Imaging studies (pre-operative and post-operative if obtained) demonstrating the fracture and the results of the vertebroplasty.* Pathology report if a bone biopsy was conducted.* Anesthesia record.
** The provided sources offer varying information about the global period for this procedure.This should be clarified with payer-specific guidelines for proper billing and reimbursement.
- Revenue Code: P5B (Ambulatory Procedures - Musculoskeletal)
- RVU: The relative value units (RVUs) vary based on the payer and location of service (office vs. facility).Consult the most recent Medicare Physician Fee Schedule or other payer's fee schedule for the current RVUs and payment amounts.
- Global Days: The global period for this procedure is not explicitly defined in the provided sources, however, it is common practice to assume a short global period, possibly 0 days given the minimally invasive nature of the procedure.Always consult payer-specific guidelines.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier does not apply to this code because it encompasses the entire procedure.
- Fee Schedule: Historical fee schedules for 22511 vary by payer and year.Consult historical payer fee schedules or billing databases for this information.
- Specialties:Orthopedic Surgery, Neurosurgery, Interventional Radiology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)