Surgical · Spine

Percutaneous vertebral augmentation of a single thoracic vertebral body, including cavity creation via mechanical device (e.g., balloon kyphoplasty), with imaging guidance included.

Verified May 8, 2026 · 8 sources ↓

Medicare: $5,801.07
Total RVUs: 173.68
Global, days: 10
Region: Spine

Drawn from CMSEvtodayBacktable

Documentation requirements

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

Source · Editorial brief grounded in 8 cited references ↓

Specify the thoracic vertebral level treated by name (e.g., T7, T10) — vague references to 'the treated level' trigger audits
Document the cavity creation technique used (balloon, PEEK implant, curette, or other mechanical device)
Confirm imaging modality used for guidance (fluoroscopy or CT) — it is bundled, but must appear in the operative note
Record the indication: vertebral compression fracture with etiology (osteoporosis, trauma, or malignancy) and supporting imaging
If bone biopsy was performed, document clearly whether it was at the same or a separate site, and note the level in item 19 of CMS-1500 if separate
For multilevel procedures, document each vertebral level individually and justify medical necessity for each additional level treated

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 79 Unrelated during global XS Separate structure

What this code covers

Source · Editorial summary grounded in 8 cited references ↓

CPT 22513 covers percutaneous vertebral augmentation at one thoracic vertebral body. The procedure involves mechanical cavity creation — typically with a balloon, PEEK implant, or curette — followed by bone cement injection to stabilize the fracture and attempt height restoration. Fluoroscopic or CT imaging guidance is bundled into the code; do not bill it separately. The descriptor is unilateral or bilateral, so modifiers 50, LT, and RT are not required and should not be appended.

For multilevel treatment, 22513 is the primary code for the first thoracic level. Use add-on code 22515 for each additional thoracic or lumbar level in the same session. Per NCCI policy, only one primary code in the 22513–22515 family is reportable per session regardless of whether additional levels are contiguous or not. Never report 22513 and 22514 together — they cover different spinal regions (thoracic vs. lumbar) and only one primary augmentation code is allowed per session. Cervical augmentation has no Category I code; use 22899. Sacral augmentation uses Category III codes.

Bone biopsy performed at the same site during the same session is considered integral and cannot be billed separately. If biopsy is at a separate site or separate session, append modifier 59 or XS and document the distinct site clearly — including the vertebral level in item 19 of the CMS-1500. The global period is 10 days. Standard multiple-procedure payment reduction rules apply when more than one level is treated on the same date.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	8.43
Practice expense RVU	163.68
Malpractice RVU	1.57
Total RVU	173.68
Medicare national rate	$5,801.07
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	$5,801.07
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI G2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 22513 get rejected.

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

Imaging guidance billed separately — it is bundled into 22513 and not separately reimbursable
Modifier 50 or LT/RT appended incorrectly — the descriptor is already unilateral or bilateral; these modifiers are not required and can trigger edits
22513 and 22514 reported together in the same session — only one primary augmentation code is allowed per session
Missing or non-specific vertebral level documentation — payers and auditors require the exact level (e.g., T8) in the operative note
Bone biopsy at the same site billed separately without modifier 59 or XS — it is integral unless performed at a distinct separate site
LCD coverage criteria not met — most MACs follow an LCD requiring conservative treatment failure, specific fracture age, and pain severity thresholds

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 8 cited references ↓

01Do I need modifier LT or RT when billing 22513?

No. CMS explicitly states that modifiers 50, LT, and RT are not required for 22513. The descriptor already covers unilateral or bilateral cannulation. Appending them can trigger claim edits without adding reimbursement.

02How do I code vertebral augmentation at both T10 and L3 in the same session?

Report 22513 as the primary code for T10 (the first level), then add-on code 22515 for the L3 level. Never report 22513 and 22514 together — only one primary augmentation code is allowed per session, and 22515 covers each additional thoracic or lumbar level regardless of region.

03Is imaging guidance separately billable with 22513?

No. Fluoroscopy and CT guidance are bundled into 22513. Billing them separately will result in denial or downcoding. Document the modality in the operative note, but do not submit a separate imaging code.

04Can I bill a bone biopsy performed at the same level during the same session?

No. Bone biopsy at the same vertebral level during the same session is considered integral to 22513. You may bill it separately only if it was performed at a different site — in that case, append modifier 59 or XS and identify the biopsy site in item 19 of the CMS-1500.

05What code do I use for thoracic vertebral augmentation at a second non-contiguous level?

Still use 22515. Per NCCI policy, the add-on code 22515 applies to each additional thoracic or lumbar vertebral body in the same session whether the levels are contiguous or not. Report one unit of 22515 per additional level treated.

06What is the global period for 22513, and what does it cover?

22513 carries a 10-day global period. That covers routine post-procedure care through day 10. Services unrelated to the augmentation procedure during that window require modifier 24 (E/M) or 79 (unrelated procedure).

07How do I code vertebral augmentation in the cervical spine?

There is no Category I CPT code for cervical vertebral augmentation. Use unlisted code 22899 with supporting documentation. Do not substitute the cervical vertebroplasty code 22510 — that describes a different procedure.

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 thoracic vertebral level by name (e.g., T7), the cavity creation method (balloon, curette, PEEK implant), imaging modality used, and whether bone biopsy was performed and at which site. That detail prevents the two most common 22513 denials: missing level specificity and improperly unbundled biopsy charges.

See how Mira captures CPT 22513 documentation