Fusion · Spine

Percutaneous vertebroplasty of one lumbosacral vertebral body, unilateral or bilateral cement injection, with all imaging guidance included.

Verified May 8, 2026 · 7 sources ↓

Medicare: $1,773.92
Total RVUs: 53.11
Global, days: 10
Region: Spine

Drawn from EvtodayCMSAAPCProvider

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify the specific vertebral body treated by level (e.g., L2, L3, S1) — do not use 'lumbosacral spine' alone.
Specify the imaging modality used for guidance (fluoroscopy, CT, or other) and describe how it directed needle placement.
Confirm no mechanical cavity creation occurred — if a balloon or device created a cavity before cement injection, kyphoplasty codes (22514) apply instead.
Document failure or contraindication of conservative management prior to procedure to support medical necessity.
Note whether bone biopsy was performed and at which level; if at a separate site, document that site distinctly.
Record laterality of needle placement (unilateral or bilateral transpedicular) even though modifier 50/LT/RT is not required — audit teams expect operative detail.
Document cement type, volume injected per level, and any intraoperative fluoroscopic or CT confirmation of cement distribution.

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 XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

22511 covers percutaneous vertebroplasty at the lumbosacral spine — one vertebral body, regardless of whether injection is unilateral or bilateral. Bone cement (typically polymethylmethacrylate) is injected through the skin into the fractured vertebral body under image guidance. The code bundles imaging guidance (fluoroscopy, CT, or other modality), bone biopsy when performed at the same level, moderate sedation, and intraosseous venography. Nothing in that list can be billed separately for the same session at the same level.

For additional lumbosacral or cervicothoracic vertebral bodies treated in the same session, add +22512 once per additional level. Do not append modifier 51 or 59 to 22512 — it is an add-on code. Do not append modifier 50 or LT/RT to 22511; the descriptor already covers unilateral or bilateral injection per vertebral body. If the procedure spans the cervicothoracic and lumbosacral regions, select a single primary-level code based on the first vertebral body treated.

The 10-day global period means routine follow-up through day 10 is included. Bone biopsy performed at a separate site during the same session can be billed separately — use modifier 59 or XS and document the distinct site clearly, identifying the level in item 19 of the CMS-1500. Vertebroplasty (22511) and vertebral augmentation/kyphoplasty (22514) are distinct procedures; code selection hinges on whether a cavity was created mechanically before cement injection. If a cavity was created, kyphoplasty codes apply.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.15
Practice expense RVU	44.89
Malpractice RVU	1.07
Total RVU	53.11
Medicare national rate	$1,773.92
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	$1,773.92
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 22511 get rejected.

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

Medical necessity not established — no documentation of failed conservative treatment or clinical criteria supporting intervention.
Imaging guidance billed separately (e.g., fluoroscopy code added alongside 22511) — imaging is bundled and not separately payable at the same level.
Bone biopsy (20225) billed at the same level as vertebroplasty — biopsy at the treated level is integral and not separately reimbursable.
Modifier 50 or LT/RT appended to 22511 — the descriptor covers unilateral or bilateral; these modifiers are incorrect here and trigger edits.
22512 billed as a standalone code rather than as an add-on to 22511 or 22510 — 22512 requires a primary-level code on the same claim.
Vertebroplasty coded when operative note describes cavity creation — cavity creation mandates kyphoplasty codes (22513–22515), not 22511/22512.

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 7 cited references ↓

01Do I need modifier 50 if the surgeon placed needles bilaterally?

No. The 22511 descriptor covers unilateral or bilateral injection per vertebral body. Do not append modifier 50, LT, or RT — CMS explicitly states these modifiers are not required for 22510–22515, and appending them will trigger claim edits.

02How do I code vertebroplasty at L3 and L4 on the same day?

Bill 22511 for the first lumbosacral level, then add +22512 for each additional level. For L3 and L4, that's 22511 plus 22512 x1. Do not append modifier 51 or 59 to the add-on code.

03Can I bill separately for fluoroscopy or CT guidance used during 22511?

No. Imaging guidance is bundled into 22511 regardless of modality. Billing a separate fluoroscopy or CT guidance code at the same level on the same date violates NCCI bundling rules and will be denied.

04The surgeon performed a bone biopsy at a different level than the vertebroplasty. Can I bill it separately?

Yes — biopsy at a separate site is billable. Append modifier 59 or XS to the biopsy code and document the distinct level clearly. Identify the biopsy site in item 19 of the CMS-1500 or its electronic equivalent.

05What is the difference between 22511 and 22514?

22511 is vertebroplasty — cement injected directly into the fractured vertebral body without prior cavity creation. 22514 is lumbar kyphoplasty — a mechanical device (balloon or similar) creates a cavity before cement is injected. If the operative note describes cavity creation, 22514 applies. Billing 22511 when a cavity was created is a common audit target.

06Does 22511 carry a global period, and what does that mean for follow-up billing?

22511 has a 10-day global period. Routine post-procedure visits within those 10 days are included and cannot be billed separately. Unrelated E/M services in the global window need modifier 24.

07Can I bill 22511 and 22510 together if the surgeon treated both cervicothoracic and lumbosacral levels?

No. Select a single primary-level code based on the first vertebral body treated, then use +22512 for each additional level regardless of region. You cannot bill both 22510 and 22511 on the same date for the same patient.

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, imaging modality and guidance technique, laterality of needle placement, cement type and volume, whether bone biopsy was performed and at which site, and explicit confirmation that no mechanical cavity creation occurred. That last point prevents the single most common audit flag on this code — a note that describes a balloon or device being used but bills vertebroplasty instead of kyphoplasty, which draws payer scrutiny and potential fraud flags.

See how Mira captures CPT 22511 documentation