Surgical · Spine

Add-on code for each additional cervicothoracic or lumbosacral vertebral body treated with percutaneous vertebroplasty during the same session as the primary procedure.

Verified May 8, 2026 · 7 sources ↓

Medicare: $739.83
Total RVUs: 22.15
Global, days
Region: Spine

Drawn from CMSEvtodayStreamlinemdAAPC

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 level(s) treated (e.g., T7, L2) — note each level in the operative report and on the claim form (item 19 of CMS-1500 or electronic equivalent)
Document that cement injection was performed at each additional level, including needle placement approach (unilateral or bilateral transpedicular)
Record the imaging modality used for guidance (fluoroscopy, CT, or combination) — imaging is bundled, but the modality must be documented in the operative note
Confirm the primary vertebroplasty code (22510 or 22511) is reported for the first level treated; 22512 cannot be billed without a primary code
If bone biopsy was performed at the same site, document it as integral to the vertebroplasty — do not bill separately unless the biopsy was at a separate anatomic site
Confirm conservative treatment failure or clinical indication supporting each level treated, consistent with CMS coverage criteria for vertebral compression fracture

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

22512 is a per-level add-on code reported once for each additional cervicothoracic or lumbosacral vertebral body treated with percutaneous vertebroplasty beyond the first level. It always pairs with a primary code — either 22510 (cervicothoracic) or 22511 (lumbosacral) — and cannot stand alone. The code covers unilateral or bilateral needle placement and cement injection, all imaging guidance required to complete the procedure, and bone biopsy when performed at the same site. Do not bill imaging supervision separately.

When treating levels that span the cervicothoracic and lumbosacral regions in the same session, select one primary code for the first level and report 22512 for each additional level. Because 22510 and 22511 cannot be reported together, the level with the higher work RVU is typically designated the primary procedure. 22512 is explicitly excluded from modifier 51 reduction — it is an add-on code and CMS standard multiple-procedure payment rules govern reimbursement when more than one level is treated the same day.

The global period for 22512 is ZZZ, meaning it has no independent global period and is always tied to the primary procedure's global. CMS confirms modifiers 50, LT, and RT are not required — the descriptor already covers unilateral or bilateral injection. Bone biopsy at the same site is bundled; bill separately only when biopsy is at a distinct site, and append modifier 59 or XS with documentation identifying that site. Intraosseous venography performed during the same session is not separately payable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	3.9
Practice expense RVU	17.53
Malpractice RVU	0.72
Total RVU	22.15
Medicare national rate	$739.83
Global period	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	$739.83

Common denial reasons

The recurring reasons claims for CPT 22512 get rejected.

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

22512 billed without a primary 22510 or 22511 on the same claim — add-on codes cannot stand alone
Modifier 51 appended to 22512 triggering incorrect multiple-procedure reduction — add-on codes are exempt from modifier 51
Bone biopsy billed separately (e.g., 20220 or 20225) at the same vertebral level — bundled into 22512 per NCCI policy
Imaging guidance billed separately (e.g., 77003, 77012) during the same session — included in the 22510–22512 code family
Intraosseous venography coded separately during the operative session — CMS considers it integral and will not pay separately
Failure to document each treated level by name, resulting in medical necessity denial or downcoding to a single-level procedure

Frequently asked questions

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

01Can 22512 be billed without 22510 or 22511?

No. 22512 is an add-on code and must always be listed separately in addition to a primary vertebroplasty code. A claim with only 22512 will be denied.

02Do I need modifier 51 on 22512?

No. Add-on codes are exempt from modifier 51. Appending it can trigger an incorrect multiple-procedure payment reduction. Report 22512 without modifier 51.

03What if I treat levels in both the thoracic and lumbar regions — which is the primary code?

Pick one level as primary (either 22510 for cervicothoracic or 22511 for lumbosacral) and report 22512 for each additional level. Because 22510 and 22511 cannot be reported together, most providers designate the level with higher work RVUs as primary.

04Is bone biopsy separately billable when performed during vertebroplasty?

Only if the biopsy is at a different anatomic site from the vertebroplasty levels. Biopsy at the same site is bundled into 22510–22512. If billing a separate-site biopsy, append modifier 59 or XS and identify the site in item 19 of the CMS-1500.

05Do modifiers LT and RT apply to 22512?

No. CMS explicitly states modifiers 50, LT, and RT are not required for 22510–22512. The descriptor already covers unilateral or bilateral injection per vertebral body.

06Can I separately bill imaging guidance used during a multi-level vertebroplasty?

No. All imaging guidance — whether fluoroscopy, CT, or a combination — is included in the 22510–22512 code family. Billing imaging separately will be denied under NCCI bundling rules.

07What is the global period for 22512?

ZZZ. That means 22512 carries no independent global period — it inherits the global period of the primary procedure code (22510 or 22511) reported on the same claim.

Sources & references

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

Mira AI Scribe

Mira's AI scribe captures each vertebral level treated, needle placement approach (unilateral vs. bilateral transpedicular), cement injection confirmation, and imaging modality from dictation — automatically flagging if a primary 22510 or 22511 is absent. This prevents the most common denial for 22512: submitting the add-on without its required primary code, or missing per-level documentation that payers use to verify medical necessity for multi-level billing.

See how Mira captures CPT 22512 documentation