Surgical · Spine

Percutaneous vertebroplasty of one cervicothoracic vertebral body, including cavity creation, fracture reduction, and bone biopsy when performed — all under imaging guidance.

Verified May 8, 2026 · 5 sources ↓

Medicare: $1,763.23
Total RVUs: 52.79
Global, days: 10
Region: Spine

Drawn from CMSAAPCMdclarity

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

Specify the vertebral level(s) treated by name (e.g., C7, T1) — 'cervicothoracic level' alone is insufficient for audit.
Document failure or contraindication of conservative management prior to the procedure.
Confirm imaging modality used for guidance (fluoroscopy, CT) — guidance is bundled but must be documented.
If bone biopsy was performed, document that in the operative note; it is included in 22510 and not separately billable.
For neoplastic fractures, record the dual-diagnosis: pathological fracture code paired with the qualifying malignancy code.
Document the volume and type of bone cement injected and any intraoperative fluoroscopic or CT confirmation of cement fill.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 24 Unrelated E/M during global 25 Significant separate E/M

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 22510 covers percutaneous vertebroplasty at the cervicothoracic spine (C7–T1 junction and adjacent levels), where bone cement is injected into a compromised vertebral body to stabilize an osteoporotic compression fracture or pathological fracture from neoplastic disease. Cavity creation, fracture reduction, and bone biopsy are included in the code when performed — don't bill those separately. The procedure is performed under imaging guidance, which is also bundled. The code is reported per vertebral body; for each additional cervicothoracic level, append 22512.

Modifiers 50 and LT/RT are not required — the descriptor is already unilateral or bilateral per vertebral body. When multiple levels are treated on the same date, standard multiple-procedure reduction rules apply. The 10-day global period means routine follow-up through day 10 is bundled; use modifier 24 for unrelated E&M visits within that window.

Medical necessity hinges on diagnosis code precision. Medicare's billing and coding article (A57872) limits coverage to osteoporotic compression fractures and pathological fractures from neoplastic disease. For malignant fractures, a dual-diagnosis requirement applies: M84.58XA or M84.58XS must be paired with the qualifying neoplasm code (C41.2, C79.51, C79.52, C90.00, C90.01, or C90.02). Missing the paired code is a clean denial.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.7
Practice expense RVU	43.93
Malpractice RVU	1.16
Total RVU	52.79
Medicare national rate	$1,763.23
Global period	10 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$1,763.23
HOPD (APC 5113) Hospital outpatient department	$3,342.87
ASC (PI G2) Ambulatory surgical center (freestanding)	$1,644.87

Common denial reasons

The recurring reasons claims for CPT 22510 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or mismatched ICD-10 diagnosis — neoplastic fractures require dual-diagnosis coding (M84.58XA/S plus qualifying cancer code).
Billing imaging guidance separately when it is bundled into 22510.
Billing bone biopsy separately — it is included in the code when performed at the same level.
Insufficient documentation of conservative treatment failure before the procedure.
Billing 22510 with modifiers 50, LT, or RT — CMS instructs those modifiers are not required and their presence can trigger edits.
Reporting 22510 for thoracic or lumbar levels — those require 22513 or 22514 respectively.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Do I need modifier 50, LT, or RT on 22510?

No. Per CMS billing and coding article A57872, modifiers 50, LT, and RT are not required for 22510. The descriptor covers unilateral or bilateral work at one vertebral body. Appending them can trigger unnecessary edits.

02How do I bill for a second cervicothoracic level treated on the same date?

Add-on code 22512 covers each additional cervicothoracic or thoracic vertebral body. Standard multiple-procedure reduction rules apply when both codes appear on the same claim.

03Is imaging guidance separately billable with 22510?

No. Imaging guidance is bundled into 22510. Billing a fluoroscopy or CT guidance code separately will be denied as a component of the primary procedure.

04What ICD-10 codes support medical necessity for 22510 under Medicare?

Medicare covers osteoporotic compression fractures and pathological fractures from neoplastic disease. Malignant fracture codes M84.58XA or M84.58XS require a paired qualifying malignancy code (C41.2, C79.51, C79.52, C90.00, C90.01, or C90.02) — dual diagnosis is required.

05Can I bill separately for the bone biopsy performed during vertebroplasty?

No. Bone biopsy is included in 22510 when performed at the same vertebral body. Billing it separately will be bundled and denied.

06What is the global period for 22510, and what does it include?

22510 carries a 10-day global period. Routine post-procedure visits within that window are bundled. Use modifier 24 on E&M services for unrelated conditions seen within the 10-day global.

07Is 22510 appropriate for thoracic or lumbar vertebroplasty?

No. 22510 is specific to the cervicothoracic spine. Use 22513 for thoracic and 22514 for lumbar vertebral bodies. Miscoding the spinal region is a top reason for level-of-service mismatches and denials.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the treated vertebral level by name, the imaging modality used, whether cavity creation and/or bone biopsy were performed, and confirmation of cement fill — pulling these details directly from dictation. That documentation set prevents the two most common audit flags: vague level identification and separately billed bundled services.

See how Mira captures CPT 22510 documentation