Surgical · Spine

Percutaneous vertebral augmentation of one lumbar vertebral body using a mechanical device (e.g., kyphoplasty), including cavity creation, unilateral or bilateral cannulation, and all imaging guidance. Fracture reduction and bone biopsy are included when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $5,805.74
Total RVUs: 173.82
Global, days: 10
Region: Spine

Drawn from CMSEvtodayStrykerPriorityhealth

Documentation requirements

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

Source · Editorial brief grounded in 6 cited references ↓

Identify the specific lumbar vertebral level(s) treated by name (e.g., L2, L3) in the operative note and on the claim form
Confirm imaging guidance was used and document the modality (e.g., biplane fluoroscopy, CT) in the procedure note
Document whether cavity creation was performed and the mechanical device used (e.g., balloon, curette, peek implant)
Record the type and volume of cement injected and confirm unilateral or bilateral cannulation approach
If bone biopsy was performed, document the biopsy site; if at the same level as augmentation, no separate code is appropriate
If bone biopsy is at a distinct site, document that site separately and append modifier 59 or XS to the biopsy code
Legible physician signature on all procedure documentation; every page must include patient name and date of service

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 6 cited references ↓

22514 covers percutaneous vertebral augmentation at a single lumbar level. The procedure involves mechanically creating a cavity within the fractured vertebral body — typically via balloon inflation, a peek implant, or a curette — then injecting bone cement to stabilize the fracture and restore vertebral height. Imaging guidance and bone biopsy (when performed) are bundled; do not bill them separately unless the biopsy is at a distinct site. The descriptor is inherently unilateral or bilateral, so modifiers 50, LT, and RT are not required and should not be appended.

22514 is the lumbar counterpart to 22513 (thoracic). When additional lumbar or thoracic levels are treated in the same session, add 22515 for each additional vertebral body. 22513 and 22514 are never reported together for the same session — use whichever matches the primary level treated. Cervical vertebral augmentation has no Category I code; report 22899. The global period is 010, meaning routine follow-up care is included for 10 days post-procedure.

Multiple-procedure payment reduction rules apply when 22514 and 22515 are billed together. The HOPD and ASC settings have distinct payment rates, and the 22514+22515 pair no longer qualifies for a complexity adjustment under HOPD — it reimburses out of APC 5114. Document the specific lumbar level treated (e.g., L2) in item 19 of the CMS-1500 or its electronic equivalent when applicable.

RVU & reimbursement

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

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	7.79
Practice expense RVU	164.59
Malpractice RVU	1.44
Total RVU	173.82
Medicare national rate	$5,805.74
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	$5,805.74
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 22514 get rejected.

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

Bone biopsy billed separately at the same vertebral level — it is bundled into 22514 and will deny without a distinct-site modifier
Modifiers 50, LT, or RT appended — these are not required; the descriptor already covers unilateral or bilateral cannulation and their presence can trigger edits
22514 and 22513 both reported for the same session — only one primary augmentation code is allowed per session regardless of how many levels are treated
Missing or non-specific level documentation — failure to identify the lumbar level treated in item 19 or the operative note triggers medical necessity and coding review
Imaging guidance billed separately (e.g., fluoroscopy codes) — imaging is bundled into 22514 and will deny as a component service
Fracture reduction or bone biopsy billed as separate codes at the same site — both are included in the 22514 descriptor

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Do I need modifier 50, LT, or RT on 22514?

No. The 22514 descriptor covers a single vertebral body with unilateral or bilateral cannulation. Appending 50, LT, or RT is incorrect and can trigger NCCI edits or overpayment flags. CMS billing and coding article A57872 explicitly states these modifiers are not required.

02How do I bill when two lumbar levels are treated in the same session?

Report 22514 once for the primary lumbar level, then add 22515 for each additional thoracic or lumbar vertebral body treated. Standard multiple-procedure payment reduction rules apply. Do not report 22514 twice.

03Can I bill 22514 and 22513 together for the same session?

No. 22513 and 22514 are never reported together for the same operative session. Use whichever code matches the primary level treated — thoracic (22513) or lumbar (22514) — and add 22515 for each additional level.

04Is bone biopsy separately billable when performed during 22514?

Only if the biopsy is at a different site than the augmentation. When performed at the same vertebral level, biopsy is bundled into 22514. A biopsy at a distinct site requires modifier 59 or XS and documentation clearly identifying the separate site.

05What code applies if the patient has a lumbar augmentation and a sacral augmentation in the same session?

Report 22514 for the lumbar level and 0200T (unilateral) or 0201T (bilateral) for the sacral augmentation. Sacral vertebral augmentation is not covered by 22514 or 22515 — those codes apply only to thoracic and lumbar vertebrae.

06What is the global period for 22514 and what does it include?

22514 carries a 010 global period — 10 days post-procedure. Routine follow-up visits within that window are included. Services unrelated to the augmentation require modifier 24 on E/M codes billed during the global.

07Is fluoroscopic guidance billed separately with 22514?

No. Imaging guidance is bundled into 22514. Billing a separate fluoroscopy or CT guidance code for the same procedure will deny as a component service under NCCI bundling rules.

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 lumbar level treated, the mechanical device used for cavity creation, cannulation approach (unilateral vs. bilateral), cement type and volume, and imaging modality from dictation — all in the operative note. That prevents the two most common audit flags: missing level specificity on the claim and separately billed imaging or biopsy that is already bundled into 22514.

See how Mira captures CPT 22514 documentation