Kyphoplasty CPT Code Billing (22510–22515): Vertebroplasty vs Augmentation, LCD Rules and Clean Claims

Is the cement injected straight into the bone, or does a balloon or other device first create a cavity? That one detail decides the code family. With a cavity, the procedure is vertebral augmentation, and the kyphoplasty CPT code is 22513 for a thoracic vertebral body or 22514 for a lumbar one, with +22515 for each additional level. Vertebroplasty, which skips the cavity step, uses 22510 for cervicothoracic, 22511 for lumbosacral and +22512 for added levels.

Clean claims then depend on three things: one primary code per session, no separate billing for imaging or biopsy, and records that meet your Medicare contractor’s vertebral augmentation LCD.

Vertebroplasty vs Vertebral Augmentation

Both procedures treat vertebral compression fractures with bone cement, but CPT splits them by technique.

In vertebroplasty, the physician injects cement directly into the fractured vertebral body. As a result, the vertebroplasty vs kyphoplasty CPT 22510-22512 range is organized by region: cervicothoracic or lumbosacral.

In vertebral augmentation, a mechanical device first creates a cavity that the cement then fills. Balloon kyphoplasty is the best-known example, but CPT 22513 to 22515 also cover other cavity-creating devices.

The key differences:

• Cavity: vertebroplasty injects cement directly, while augmentation creates a cavity first.
• Height: augmentation may restore some height; vertebroplasty does not.
• Regions: vertebroplasty reaches the cervical spine; augmentation covers T1 to L5 only.

So vertebral augmentation billing starts with one question: did a device create a cavity? If yes, use the 22513 family. If not, use the 22510 family, even if the note says kyphoplasty.

Kyphoplasty CPT Code by Region and Level

The six codes below cover both families, including every kyphoplasty CPT code. Each primary code reports the first vertebral body treated, and each add-on reports one more.

Choosing the Primary Code

CPT 22513 22514 22515 follow the level of the first vertebral body treated. For a single T11 fracture, report 22513. For a single L2 fracture, report 22514 instead.

Adding Levels Across Regions

Only one primary code is reported per session. Therefore, a T12 and L1 kyphoplasty is 22513 plus +22515, not 22513 plus 22514, because the add-on covers any additional thoracic or lumbar body. Likewise, +22512 covers any added vertebroplasty level. For a broader view of level counting in spine claims, see our multi-level spinal fusion billing guide.

What the Codes Include and Kyphoplasty Modifiers

All six codes are built as complete packages. So most add-on charges coders are tempted to add will fail NCCI edits.

Included, never billed separately: all imaging guidance, including fluoroscopy or CT. Bone biopsy at the treated level, cavity creation, fracture reduction and the cement itself are also included. In addition, unilateral and bilateral cannulation pay the same.

Billable only in specific cases: a bone biopsy, 20225, at a different vertebra that is not augmented, with a distinct-site modifier such as XS.

Kyphoplasty modifiers follow from that package. Do not add 50, RT or LT, because the code already covers one or both sides. Use 58 when a second level is planned and treated in a later session. Similarly, use 78 or 79 for a return to the procedure room during the 10-day global period.

Vertebral Augmentation LCD Rules

Each Medicare contractor publishes its own vertebral augmentation LCD, such as L38201 for CGS, L34228 for Noridian and L35130 for Novitas. Still, the core criteria match closely. Before scheduling, confirm the chart shows each item below.

• An osteoporotic compression fracture from T1 to L5 that is acute (under 6 weeks) or subacute (6 to 12 weeks)
• MRI showing bone marrow edema, or a bone scan or CT confirming an active fracture
• Pain of 5 or higher on a 0–10 scale, or 8 or higher if hospitalized, despite optimal non-surgical care
• Failed non-surgical management, such as medication and physical therapy
• Signs of progression, such as height loss over 25%, kyphotic deformity or a disability score above the LCD threshold
• No exclusions, such as infection, back pain from another cause or retropulsed fragments
• A referral for bone density evaluation and osteoporosis care

For the vertebral compression fracture ICD-10 code, M80.08XA reports an age-related osteoporotic vertebral fracture at the initial encounter. For pathologic fractures from cancer, most contractors pair M84.58XA with the cancer code. Our post on documenting failed conservative treatment shows how to record the non-surgical care step.

Billing by Site of Service

The same kyphoplasty pays differently depending on where it happens. The setting decides how many claims go out and which rate the physician receives.

Kyphoplasty ASC Billing

For kyphoplasty ASC billing, the center bills the primary kyphoplasty CPT code on its own claim. In 2026, Medicare pays 22513 and 22514 in the ASC under indicator G2, while +22515 carries indicator N1. That means added levels are packaged and do not pay separately, although the center still reports them. In hospital outpatient departments, 22513 and 22514 map to a comprehensive APC instead. Our ASC billing and coding strategies cover how centers handle packaged lines.

Cervical Kyphoplasty 22899

The 22513 family stops at thoracic and lumbar levels. So cervical kyphoplasty 22899, the unlisted spine code, applies when a device creates a cavity in a cervical body. In contrast, cervical vertebroplasty without a cavity still fits 22510. With 22899, attach the operative note and a comparable code to support pricing.

Documentation That Survives RAC Review

Vertebral augmentation is an approved Recovery Audit topic. Under RAC topic 0139, auditors review 22510 to 22515 claims from hospitals, ASCs and physicians for medical necessity. They focus on initial procedures, repeat procedures and multi-level cases. Denied claims become overpayments, so the record must stand on its own.

An auditor will look for these records, in this order:

1. The imaging report that dates the fracture and confirms edema or uptake at each treated level.
2. The pain and function scores recorded before the procedure, using the scale your LCD names.
3. The non-surgical care history, with dates, medications and therapy tried.
4. The operative note, stating the levels, whether a device created a cavity and the approach used.
5. A level-by-level rationale when more than one vertebra is treated or the patient returns for another level.

In short, every billed level needs its own imaging proof and clinical reason. For other spine services under added payer scrutiny, see our post on CMS WISeR and spine claims.

Clean Claims: Five Kyphoplasty Errors to Fix

Most denials on a kyphoplasty CPT code claim trace back to a handful of coding slips. Catch them before submission, and the claim goes out clean.

1. 22513 and 22514 Billed Together

A T12 and L1 case spans two regions, so coders often bill 22513 and 22514 together. CPT allows only one primary code per session, so the second line denies. Instead, report the first level as primary and each added level as +22515.

2. Imaging Guidance Billed Separately

Fluoroscopy and CT guidance, such as 77003 or 77012, are already part of all six codes, so NCCI edits bundle them. Remove them from the procedure-day charges. However, a diagnostic MRI on an earlier date stays billable.

3. Bone Biopsy at the Treated Level

A biopsy at the treated level is included, so 20225 will not pay there. Bill it only for a different, untreated vertebra with modifier XS. Meanwhile, the pathologist still bills for the specimen.

4. No Device Cavity in the Note

Augmentation pays more than vertebroplasty, so a note with no device or cavity looks like upcoding. Use a template that records the device, cavity, levels and cement volume. If the note is unclear, query the physician or code 22510 or 22511.

5. A Level Without Imaging Proof

Each treated level needs imaging that shows an acute or subacute fracture, and RAC topic 0139 targets multi-level cases. So match every billed level to the imaging report. When LCD criteria may not be met, discuss an Advance Beneficiary Notice first.

Three Checks Behind Every Kyphoplasty Claim

Every vertebral augmentation claim rests on three checks. First, the technique: a device-made cavity points to the kyphoplasty CPT code family, and direct injection points to vertebroplasty. Next, the levels: one primary code for the first body, then an add-on for each one after it. Finally, the proof: imaging, pain scores and failed conservative care that match your LCD for every level billed.

Spine surgeons, interventional teams and surgery centers that run these checks before submission are far better prepared for RAC review. For coding and audit support on these cases, explore our spine surgery billing services.

Kyphoplasty CPT Code FAQs