2025 CPT code 22513

Percutaneous vertebral augmentation of one thoracic vertebral body, including cavity creation (fracture reduction and bone biopsy included when performed) using a mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulation, with all imaging guidance.

Follow current CPT coding guidelines and any payer-specific instructions.Bone biopsy, when performed, is considered integral to the procedure and not separately reportable unless performed at a different site or during a separate session.

Modifiers 50 (bilateral procedure), 51 (multiple procedures), 52 (reduced services), and others may be applicable depending on the circumstances.Always refer to the CPT manual and payer guidelines for accurate modifier application.

Medical necessity for 22513 is typically established when a patient presents with a painful vertebral compression fracture refractory to conservative management, and the procedure is deemed the most appropriate method to relieve pain and stabilize the fracture.Documentation must support the diagnosis and the rationale for the procedure.

The procedure is typically performed by a surgeon, interventional radiologist, or other qualified healthcare professional specializing in spine procedures. The physician is responsible for patient assessment, procedure planning, performing the procedure, post-procedure monitoring, and providing appropriate follow-up care.

IMPORTANT 22514 (lumbar), 22515 (additional vertebral bodies), 22510-22512 (other vertebral augmentation techniques)

In simple words: This code covers a minimally invasive spine surgery to repair a broken bone in the upper or middle back (thoracic spine).A small instrument is inserted through the skin to create space in the broken bone, which is then filled with special cement to stabilize it.This may involve removing a small bone sample for testing.

This CPT code encompasses the percutaneous vertebral augmentation procedure for a single thoracic vertebral body.The procedure involves creating a cavity (which may include fracture reduction and bone biopsy if performed), followed by the injection of a material (e.g., bone cement) using a mechanical device such as a kyphoplasty system.Unilateral or bilateral cannulation may be employed. The code includes all necessary image guidance (e.g., fluoroscopy, CT).

Example 1: A 70-year-old female with osteoporosis presents with a painful compression fracture of T8.22513 is used to perform kyphoplasty., A 55-year-old male with a history of metastatic cancer to the spine experiences severe pain from a compression fracture of T12.22513 is used to perform vertebroplasty with bone biopsy for pathological assessment., A 62-year-old female with osteoporotic compression fractures in T6 and T7 undergoes a percutaneous vertebral augmentation. 22513 is reported for T6 and 22515 is added for T7.

* Pre-operative imaging (X-ray, CT scan) demonstrating the compression fracture.* Operative report detailing the procedure performed, including the number of vertebral bodies treated, unilateral or bilateral approach, use of balloon or other device, type of bone cement used, and any complications.* Post-operative imaging to confirm successful vertebral augmentation.* Pathology report if bone biopsy was performed.* Patient's medical history relevant to the fracture (e.g., osteoporosis, cancer).

** Always verify coding with the most up-to-date CPT manual and payer guidelines.The reimbursement for this procedure can be affected by various factors, including the use of a balloon device, the type of cement used, and the number of vertebral bodies treated.Appropriate documentation is crucial for accurate coding and reimbursement.

  • Revenue Code: P5B (Ambulatory Procedures - Musculoskeletal)
  • RVU: The RVUs for this code vary based on geographic location, facility type, and other factors. Consult the relevant fee schedule for current values.
  • Global Days : The global period for this procedure is not explicitly defined in the CPT guidelines.Check payer-specific guidelines for any applicable global period.
  • Payment Status: Active
  • Modifier TC rule: A technical component (TC) modifier is not typically applicable to 22513. This code is generally considered a complete procedure. However, consult your specific payer guidelines for clarification.
  • Fee Schedule : Historical fee schedule data can be obtained from various sources such as CMS, private payers, and commercial databases.These values fluctuate by year, location, and payer.
  • Specialties:Orthopedic Surgery, Neurosurgery, Interventional Radiology
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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