Glossary · Clinical

Kyphoplasty

Kyphoplasty is a minimally invasive percutaneous vertebral augmentation procedure in which a mechanical device creates a cavity inside a fractured vertebral body before bone cement is injected—distinguishing it from vertebroplasty, which skips the cavity-creation step.

Verified May 8, 2026 · 7 sources ↓

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Definition

Source · Editorial summary grounded in 7 cited references ↓

In kyphoplasty, the surgeon advances one or two cannulas into the collapsed vertebral body under imaging guidance, then inflates a balloon-like mechanical device to create a cavity and partially restore vertebral height. Once the device is removed, bone cement fills the cavity and stabilizes the fracture. The mechanical cavity-creation step is the defining clinical and coding feature: CPT descriptors for codes 22513 and 22514 require it, and its absence means the procedure should be reported as vertebroplasty instead.

The procedure is most commonly performed for painful vertebral compression fractures (VCFs) caused by osteoporosis or malignancy in the thoracic and lumbar spine. CMS covers it for fractures meeting pathological criteria—specifically osteoporotic or neoplastic etiologies—but does not cover it for traumatic fractures. Cervical-level procedures lack a dedicated CPT code and are reported with the unlisted-spine code 22899.

For billing purposes, 22513 covers a single thoracic level, 22514 covers a single lumbar level, and add-on code +22515 applies to each additional thoracic or lumbar level in the same session. Imaging guidance—whether fluoroscopic or CT—is bundled into all three codes and must never be billed separately. Bone biopsy and fracture reduction, when performed at the same level, are also bundled.

Why it matters

Selecting the wrong code between kyphoplasty (22513/22514/+22515) and vertebroplasty (22510/22511/+22512) is one of the most audited distinctions in spine procedural billing. The cavity-creation step must be clearly documented in the operative note; without it, payers will downcode to vertebroplasty or deny the claim outright. Additionally, separately billing imaging guidance alongside 22513 or 22514 triggers NCCI edit denials, because guidance is bundled. Getting these distinctions right protects reimbursement and shields the practice from post-payment audits under Local Coverage Determinations.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Billing 22513 or 22514 when the operative note does not explicitly document cavity creation with a mechanical device—absent documentation, payers will downcode to vertebroplasty codes.
Reporting fluoroscopic or CT guidance (e.g., 77003, 77012) in addition to 22513 or 22514; imaging guidance is already bundled and will trigger an NCCI edit denial.
Using +22515 as a standalone code rather than as an add-on to a primary 22513 or 22514—it must always be listed in addition to the primary-level code.
Billing for an assistant surgeon at kyphoplasty: CMS assigns a 'payment restriction' indicator, meaning Medicare will not pay for an assistant at surgery on these codes.
Failing to check for payer-specific Local Coverage Determinations (LCDs) or prior-authorization requirements before scheduling, which can result in non-covered claim denials.
Using ICD-10 codes for traumatic fractures (e.g., S-category codes) rather than pathological or osteoporotic fracture codes—CMS does not cover kyphoplasty for traumatic fractures.
Reporting kyphoplasty and vertebroplasty at the same level during a single session; when both procedures are performed at different levels, each set of codes applies to its respective levels with appropriate CCI modifier review.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Modifiers

59 Distinct procedural service 26 Professional component RT Right side LT Left side

Frequently asked questions

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

01What is the single most important documentation element that separates kyphoplasty from vertebroplasty for coding purposes?

The operative note must state that a mechanical device was used to create a cavity inside the vertebral body before cement was injected. Without that cavity-creation step, the procedure does not meet the definition for CPT 22513 or 22514 and should be coded as vertebroplasty.

02Can imaging guidance be billed separately when reporting 22513 or 22514?

No. Fluoroscopic and CT guidance are bundled into 22513 and 22514. Billing them separately will generate an NCCI edit denial. Do not report 77003, 77012, or similar codes alongside the kyphoplasty primary codes.

03How do you code kyphoplasty when both thoracic and lumbar levels are treated in one session?

Report 22513 for the primary thoracic level, 22514 for the primary lumbar level, and +22515 for each additional thoracic or lumbar level beyond those two. Do not use +22515 as a standalone code.

04Does Medicare cover kyphoplasty for traumatic vertebral fractures?

No. CMS covers percutaneous vertebral augmentation only for fractures due to osteoporosis or malignancy. Traumatic fractures coded with S-category ICD-10 codes do not meet Medicare's coverage criteria and will be denied.

05What code is used for kyphoplasty at a cervical level?

There is no dedicated CPT code for cervical-level kyphoplasty or vertebroplasty. Most payers direct providers to report 22899 (unlisted procedure, spine), but you should verify with the specific payer before billing.

06Is an assistant surgeon reimbursable for kyphoplasty under Medicare?

No. CMS assigns a statutory payment restriction to these codes, meaning Medicare will not pay for an assistant at surgery on kyphoplasty procedures.

07When can a bone biopsy be billed separately during a kyphoplasty encounter?

Only when the biopsy is performed at a vertebral level not treated by the augmentation. In that case, report 20225 with modifier 59 and document the distinct site. Biopsy at the same level as the kyphoplasty is bundled and cannot be billed separately.

Sources & references

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

Mira AI Scribe

When Mira detects documentation of a percutaneous spine procedure, it checks the operative note for two required elements before suggesting kyphoplasty codes (22513/22514/+22515): (1) explicit mention of a mechanical device used to create a cavity or restore vertebral height, and (2) subsequent cement injection into that cavity. If only cement injection is documented without cavity creation, Mira will suggest vertebroplasty codes (22510/22511/+22512) instead and flag the discrepancy for coder review. Mira also automatically suppresses separate imaging guidance codes (e.g., 77003, 77012) when 22513 or 22514 is selected, as guidance is bundled. If the note documents bone biopsy at the same vertebral level as the kyphoplasty, Mira will bundle that service rather than generate a separate biopsy code. If biopsy is performed at a distinct level not addressed by the augmentation, Mira will suggest 20225 with modifier 59 and prompt the coder to confirm the separate site in documentation. For level selection: thoracic levels map to 22513 (primary) with +22515 for each additional; lumbar levels map to 22514 (primary) with +22515 for each additional. If both thoracic and lumbar levels are treated, Mira generates one 22513, one 22514, and the appropriate number of +22515 units. Cervical-level procedures trigger an alert recommending 22899 with a note to verify payer guidelines. ICD-10 suggestions are limited to osteoporotic or pathological fracture codes, and Mira will flag any traumatic fracture (S-category) ICD-10 pairing as a likely coverage exclusion under CMS LCD policy.

See Mira's approach

Related terms

Vertebroplasty Clinical

Vertebroplasty is a minimally invasive, image-guided procedure in which bone cement (typically polymethyl methacrylate, PMMA) is injected percutaneously into a fractured vertebral body to stabilize the fracture and reduce pain. It is distinct from kyphoplasty, which first creates a cavity with an inflatable balloon before cement injection.

Local Coverage Determination (LCD) Compliance

A Local Coverage Determination (LCD) is a regional Medicare policy issued by a Medicare Administrative Contractor (MAC) that defines when a specific service, procedure, or supply is considered reasonable and medically necessary within that contractor's jurisdiction.