Fusion · Spine

Add-on code for percutaneous vertebral augmentation of each additional thoracic or lumbar vertebral body beyond the first, including cavity creation with a mechanical device, imaging guidance, fracture reduction, and bone biopsy when performed. Always listed in addition to 22513 or 22514.

Verified May 8, 2026 · 7 sources ↓

Medicare: $2,977.69
Total RVUs: 89.15
Global, days
Region: Spine

Drawn from CMSStreamlinemdEvtodayBacktablePriorityhealth

Documentation requirements

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

Source · Editorial brief grounded in 7 cited references ↓

Identify each vertebral level treated by name (e.g., T10, L3) — level-by-level specificity is required, not just a general spinal region.
Describe the mechanical device used for cavity creation (balloon, curette, radiofrequency probe, etc.) — this distinguishes augmentation from vertebroplasty and determines correct code selection.
Specify the imaging guidance modality (fluoroscopy, CT, biplane fluoroscopy) and document how it was used for needle and device placement.
Document radiographic evidence of fracture (MRI, CT, or X-ray findings) to establish medical necessity for each additional level treated.
Record that conservative management was attempted and failed prior to the procedure, per CMS LCD requirements.
Note whether bone biopsy was performed and, if so, confirm it was at the same site as augmentation — a biopsy at a separate site requires modifier 59 or XS and distinct documentation.

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

51 Multiple procedures 52 Reduced services 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician XS Separate structure

What this code covers

Source · Editorial summary grounded in 7 cited references ↓

CPT 22515 is an add-on code that cannot stand alone. It reports percutaneous vertebral augmentation — cavity creation with a mechanical device (balloon, curette, or similar), followed by cement injection — at each additional thoracic or lumbar level treated beyond the primary procedure. It always pairs with 22513 (thoracic primary) or 22514 (lumbar primary). Imaging guidance, fracture reduction, and bone biopsy are all bundled into 22515; none can be billed separately for the same vertebral level.

The code covers unilateral or bilateral cannulation at the additional level — modifiers 50, LT, and RT are not required because the descriptor is already written per vertebral body regardless of approach side. Standard multiple-procedure payment adjustment rules apply when more than one level is treated on the same date. Intraosseous venography performed during the session is also included; no separate payment is allowed.

Coverage for 22515 is governed by CMS Local Coverage Determinations for percutaneous vertebral augmentation. Medicare requires that medical necessity be supported by radiographic evidence of fracture and documented failure of conservative management. Cervical augmentation is not reportable with this family of codes; use unlisted code 22899 if augmentation is performed at a cervical level.

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	84.46
Malpractice RVU	0.79
Total RVU	89.15
Medicare national rate	$2,977.69
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	$2,977.69

Common denial reasons

The recurring reasons claims for CPT 22515 get rejected.

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

Billing 22515 without a primary procedure code (22513 or 22514) — 22515 is an add-on code and will deny if submitted alone.
Failing to document medical necessity for each additional vertebral level; payers require level-specific clinical and radiographic justification, not a single global statement.
Separately billing bone biopsy (20225, 20250, 20251) or imaging guidance at the same site and same session — both are bundled into 22515.
Using 22515 for a cervical vertebral level — the code family covers thoracic and lumbar only; cervical augmentation requires 22899.
Applying modifiers 50, LT, or RT to 22515 — the descriptor is inherently unilateral or bilateral, and these modifiers are not required or appropriate per CMS guidance.

Frequently asked questions

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

01Can 22515 be billed without 22513 or 22514?

No. 22515 is an add-on code and will deny if submitted as a standalone line. It must be listed in addition to 22513 (thoracic primary) or 22514 (lumbar primary) on the same claim.

02How many times can 22515 be reported on the same date?

Once per additional vertebral level treated beyond the primary. If three levels are treated total, you bill 22513 or 22514 once plus 22515 twice. MUE limits apply — verify current MUE values in the CMS MUE table before submitting.

03Do I need modifier 50, LT, or RT on 22515 for bilateral cannulation?

No. The descriptor covers unilateral or bilateral cannulation. CMS and Priority Health both confirm that 50, LT, and RT are not required for codes 22513–22515.

04Is bone biopsy separately billable when performed during 22515?

Not at the same site. Bone biopsy is bundled into 22515. If biopsy is performed at a different site during the same session, append modifier 59 or XS to the biopsy code and document the distinct site clearly — identify the level in field 19 of the CMS 1500.

05Can 22515 be used for an additional cervical vertebral level?

No. Codes 22513–22515 cover thoracic and lumbar levels only. Cervical vertebral augmentation, regardless of technique, is reported with unlisted code 22899.

06Is imaging guidance billed separately on top of 22515?

No. Fluoroscopic or CT guidance is bundled into 22515. Billing a separate imaging guidance code for the same level on the same date will be denied as duplicate or included service.

07What diagnosis codes are typically required to support 22515 coverage?

Medicare LCDs require a vertebral compression fracture diagnosis with radiographic confirmation. Osteoporotic fractures and pathologic fractures due to malignancy are the most commonly covered indications. Review the applicable LCD and its associated billing and coding article (CMS A57872) for the current covered ICD-10-CM code list.

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 specific vertebral level of each additional augmentation (e.g., 'T10, additional level'), the mechanical device used for cavity creation, the imaging modality and technique, and whether bone biopsy was performed and at which site. That granularity prevents the two most common 22515 denials: missing level-specific medical necessity and incorrectly unbundled biopsy charges.

See how Mira captures CPT 22515 documentation