Table of Contents

Basics about Kyphoplasty & Sacroplasty Procedures codes

Percutaneous augmentation of the vertebra is performed to treat a compression fracture caused by osteoporosis, multiple myeloma, primary or metastatic malignant lesions, benign lesions, or traumatic injury of the spine. Kyphoplasty requires cavity creation (augmentation) and injection of cement to fill the cavity and replace the vertebral body marrow.

Once the cavity has been created, it is then filled with morcellized bone graft material, polymethylmethacrylate (PMMA) bone cement, or other bone graft substitute using a bone biopsy needle. The bone graft or cement is mixed with contrast medium so that the physician can observe filling of the cavity. Once the cavity is filled, the needle is withdrawn. A second injection may be performed on the opposite side of the vertebral body.

When kyphoplasty or arcuplasty (with cavity creation) is performed in the sacrum, it is called a sacroplasty. This is usually performed for vertical insufficiency fractures of the sacrum.

Description of Kyphoplasty & Sacroplasty CPT code 22513, 22514 & 22515

For percutaneous augmentation of a single thoracic vertebral body, report CPT code 22513; for a single lumbar vertebral body, use CPT code 22514; and for each additional thoracic or lumbar vertebral body, report CPT code 22515.

0200T : Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, 1 or more needles, includes imaging guidance and bone biopsy, when performed

0201T : Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, 2 or more needles, includes imaging guidance and bone biopsy, when performed

22513 : Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

RVU : 15.04

22514 : Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar

RVU: 14.00

22515 : Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)

RVU : 6.49

22899 : Unlisted procedure, spine (cervical kyphoplasty) 22899

Do and Don’t with Kyphoplasty & Sacroplasty CPT codes

Supervision and Interpretation (S&I) codes and deep bone biopsy are bundled with 22510-22515 at the same level as the intervention. Codes 0200T and 0201T also bundle these components for sacroplasty.
Kyphoplasty is similar to vertebroplasty, however it utilizes balloon or bone-cutting device to create a cavity.
Do use only one procedure code for each vertebral body treated, regardless of unilateral or bilateral approaches.
All thoracic and lumbar kyphoplasties are described as being in a single “family” of codes. Only one “initial” code is submitted per “family”. Any other levels treated are considered additional kyphoplasties.
Use code 0200T, 0201T for Kyphoplasty of the sacrum (sacroplasty)
Use unlisted code 22899 for Kyphoplasty of the cervical vertebral bodies. Code 22899 includes all the imaging and guidance.
Cavity creation should not coded as vertebroplasty

LCD Medicare coverage for CPT code 22510, 22511, 22512, 22513, 22514, 22515

Medicare is establishing the following limited coverage of 22510, 22511, 22512, 22513, 22514 and 22515 for Malignant Fractures

C41.2* Malignant neoplasm of vertebral column
C79.51* Secondary malignant neoplasm of bone
C79.52* Secondary malignant neoplasm of bone marrow
C90.00* Multiple myeloma not having achieved remission
C90.01* Multiple myeloma in remission
C90.02* Multiple myeloma in relapse
C96.5 Multifocal and unisystemic Langerhans-cell histiocytosis
C96.6 Unifocal Langerhans-cell histiocytosis
C96.A Histiocytic sarcoma
D16.6 Benign neoplasm of vertebral column
D47.1 Chronic myeloproliferative disease
E24.0 Pituitary-dependent Cushing’s disease
E24.1 Nelson’s syndrome
E24.2 Drug-induced Cushing’s syndrome
E24.3 Ectopic ACTH syndrome
E24.4 Alcohol-induced pseudo-Cushing’s syndrome
E24.8 Other Cushing’s syndrome
E24.9 Cushing’s syndrome, unspecified
M81.6 Localized osteoporosis [Lequesne]
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela

M84.58XA Pathological fracture in neoplastic disease, other specified site, initial encounter for fracture
M84.58XD Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with routine healing
M84.58XG Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with delayed healing
M84.58XK Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with nonunion
M84.58XP Pathological fracture in neoplastic disease, other specified site, subsequent encounter for fracture with malunion
M84.58XS Pathological fracture in neoplastic disease, other specified site, sequela

Traumatic Vertebral Fractures

Use 7th character, letters A, D, G, K, and S as appropriate for the code.

M48.33 Traumatic spondylopathy, cervicothoracic region
M48.34 Traumatic spondylopathy, thoracic region
M48.35 Traumatic spondylopathy, thoracolumbar region
M48.36 Traumatic spondylopathy, lumbar region
M48.37 Traumatic spondylopathy, lumbosacral region
S12.690A Other displaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S12.691A Other nondisplaced fracture of seventh cervical vertebra, initial encounter for closed fracture
S22.010A Wedge compression fracture of first thoracic vertebra, initial encounter for closed fracture
S22.011A Stable burst fracture of first thoracic vertebra, initial encounter for closed fracture
S22.012A Unstable burst fracture of first thoracic vertebra, initial encounter for closed fracture
S22.018A Other fracture of first thoracic vertebra, initial encounter for closed fracture
S22.020A Wedge compression fracture of second thoracic vertebra, initial encounter for closed fracture
S22.021A Stable burst fracture of second thoracic vertebra, initial encounter for closed fracture
S22.022A Unstable burst fracture of second thoracic vertebra, initial encounter for closed fracture
S22.028A Other fracture of second thoracic vertebra, initial encounter for closed fracture
S22.030A Wedge compression fracture of third thoracic vertebra, initial encounter for closed fracture
S22.031A Stable burst fracture of third thoracic vertebra, initial encounter for closed fracture
S22.032A Unstable burst fracture of third thoracic vertebra, initial encounter for closed fracture
S22.038A Other fracture of third thoracic vertebra, initial encounter for closed fracture
S22.040A Wedge compression fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.041A Stable burst fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.042A Unstable burst fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.048A Other fracture of fourth thoracic vertebra, initial encounter for closed fracture
S22.050A Wedge compression fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.051A Stable burst fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.052A Unstable burst fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.058A Other fracture of T5-T6 vertebra, initial encounter for closed fracture
S22.060A Wedge compression fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.061A Stable burst fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.062A Unstable burst fracture of T7-T8 vertebra, initial encounter for closed fracture
S22.068A Other fracture of T7-T8 thoracic vertebra, initial encounter for closed fracture
S22.070A Wedge compression fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.071A Stable burst fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.072A Unstable burst fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.078A Other fracture of T9-T10 vertebra, initial encounter for closed fracture
S22.080A Wedge compression fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.081A Stable burst fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.082A Unstable burst fracture of T11-T12 vertebra, initial encounter for closed fracture
S22.088A Other fracture of T11-T12 vertebra, initial encounter for closed fracture
S32.010A Wedge compression fracture of first lumbar vertebra, initial encounter for closed fracture
S32.011A Stable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.012A Unstable burst fracture of first lumbar vertebra, initial encounter for closed fracture
S32.018A Other fracture of first lumbar vertebra, initial encounter for closed fracture
S32.020A Wedge compression fracture of second lumbar vertebra, initial encounter for closed fracture
S32.021A Stable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.022A Unstable burst fracture of second lumbar vertebra, initial encounter for closed fracture
S32.028A Other fracture of second lumbar vertebra, initial encounter for closed fracture
S32.030A Wedge compression fracture of third lumbar vertebra, initial encounter for closed fracture
S32.031A Stable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.032A Unstable burst fracture of third lumbar vertebra, initial encounter for closed fracture
S32.038A Other fracture of third lumbar vertebra, initial encounter for closed fracture
S32.040A Wedge compression fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.041A Stable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.042A Unstable burst fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.048A Other fracture of fourth lumbar vertebra, initial encounter for closed fracture
S32.050A Wedge compression fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.051A Stable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.052A Unstable burst fracture of fifth lumbar vertebra, initial encounter for closed fracture
S32.058A Other fracture of fifth lumbar vertebra, initial encounter for closed fracture