Glossary · Clinical

Vertebroplasty

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.

Verified May 8, 2026 · 8 sources ↓

Drawn from CMSNIHRadiologyinfoStreamlinemdAAPC

Definition

Source · Editorial summary grounded in 8 cited references ↓

Vertebroplasty was first described in 1987 and has become a standard alternative for patients with painful vertebral compression fractures (VCFs) who have not responded to 4–6 weeks of conservative management—analgesics, bed rest, and bracing. Under fluoroscopic or CT guidance, a needle is advanced into the fractured vertebral body via a transpedicular or extrapedicular approach, and PMMA cement is injected under continuous imaging to stabilize the bone and interrupt the pain cycle. Approximately two-thirds of patients with VCFs improve with conservative care alone; vertebroplasty targets the remaining third who remain functionally limited or cannot tolerate narcotic analgesics.

The most common clinical setting is osteoporotic VCF, but CMS also covers vertebroplasty for fractures caused by neoplasm. Traumatic spinal fractures are explicitly excluded from Medicare coverage. Patient selection hinges on imaging correlation (MRI bone edema consistent with acute or subacute fracture) and failure of adequate medical therapy. Post-procedure, patients typically rest supine for 2–4 hours and ambulate the same day. Clinicians and coders must document the fracture level, imaging guidance modality, and clinical indication with precision, as these details drive both coverage determinations and code selection.

Vertabroplasty differs from kyphoplasty in that no cavity-creation step occurs; cement is injected directly into the collapsed vertebral body. This procedural distinction is codified in separate CPT families—22510–22512 for vertebroplasty versus 22513–22515 for kyphoplasty—and payers treat the two differently for medical necessity review and relative value unit (RVU) assignment. When both procedures are performed at different spinal levels during the same session, each family of codes may be reported together with appropriate CCI-edit modifier review.

Why it matters

Coding vertebroplasty incorrectly—most often by using kyphoplasty codes (22513–22515) when no balloon cavity creation was performed, or by separately billing bundled services such as intraosseous venography or fluoroscopic guidance without meeting the criteria for separate reporting—triggers payer audits, claim denials, and potential False Claims Act exposure. CMS payment policy makes vertebroplasty all-inclusive for the entire operative session, so unbundling venography or fluoroscopy into standalone line items is a common audit target. Additionally, failing to link both an osteoporosis diagnosis code and a fracture code on the same claim when the fracture is osteoporosis-related is a top reason for initial denial under local coverage determinations.

Common mistakes

Where people most often go wrong with this concept.

Source · Editorial brief grounded in cited references ↓

Reporting kyphoplasty CPT codes (22513–22515) for a procedure that did not include balloon-tamp cavity creation—vertebroplasty maps to 22510–22512.
Billing fluoroscopic guidance (72291) or CT guidance (72292) separately when CMS all-inclusive payment policy already bundles imaging supervision into the vertebroplasty payment.
Omitting the osteoporosis diagnosis code alongside the fracture code on the claim—both are required when the VCF is osteoporosis-related.
Billing bone biopsy at the same vertebral level as the vertebroplasty without modifier 59 or XS; biopsy is integral to the procedure unless performed at a distinct separate site.
Reporting an assistant-at-surgery charge—Medicare's Physician Fee Schedule Database assigns an indicator of '1' to these codes, imposing a statutory payment restriction that bars assistant payment.
Using sacral augmentation (Category III code 0201T) and expecting Medicare payment—CMS does not cover sacroplasty and an ABN must be obtained before the procedure.
Failing to document the specific vertebral level (e.g., L1) in item 19 of CMS-1500 when a separate bone biopsy at a distinct site is billed alongside vertebroplasty.

Related codes

Codes commonly involved when this concept appears in practice.

CPT

Modifiers

59 Distinct procedural service XS Separate structure 51 Multiple procedures RT Right side LT Left side

Frequently asked questions

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

01What is the difference between vertebroplasty and kyphoplasty for coding purposes?

Vertebroplasty (CPT 22510–22512) involves direct cement injection into the fractured vertebral body with no prior cavity creation. Kyphoplasty (CPT 22513–22515) adds an inflatable balloon-tamp step to reduce the fracture and create a cavity before cement is placed. Using kyphoplasty codes for a procedure that skipped the balloon step is a misrepresentation that can trigger audits and overpayment demands.

02Can fluoroscopic guidance be billed separately when reporting vertebroplasty?

Under CMS payment policy, vertebroplasty and vertebral augmentation reimbursement is all-inclusive for the operative session, which bundles intraosseous venography and imaging supervision. Fluoroscopy (72291) or CT guidance (72292) should not be separately billed to Medicare for the same session. Verify non-Medicare payer policies individually before reporting guidance codes.

03Does Medicare cover vertebroplasty for traumatic spinal fractures?

No. CMS coverage for vertebroplasty and percutaneous vertebral augmentation is limited to fractures caused by osteoporosis or neoplasm. Traumatic spinal fractures are explicitly non-covered. Practices must obtain an Advance Beneficiary Notice (ABN) before performing vertebroplasty for a traumatic fracture on a Medicare beneficiary.

04When should modifier 59 or XS be used with vertebroplasty claims?

Modifier 59 (or the more specific XS—Separate Structure) is required when a bone biopsy is performed at a different anatomical site from the vertebroplasty during the same session and is therefore a distinct service. The biopsy site (e.g., L1) must also be identified in item 19 of the CMS-1500 form. Biopsy at the same treated vertebral level is integral to the procedure and is not separately reportable.

05What documentation is required to satisfy medical necessity for vertebroplasty under an LCD?

Documentation should confirm: (1) diagnosis of an acute or subacute vertebral compression fracture consistent with imaging findings (MRI showing bone marrow edema is preferred); (2) failure of at least 4–6 weeks of appropriate conservative therapy, including analgesics; or inability to tolerate conservative management due to adverse effects; and (3) the fracture etiology (osteoporosis or neoplasm). Both the osteoporosis code and the fracture code must appear on the claim when applicable.

06What are the key post-procedure complications a coder should be aware of for follow-up visits?

Clinically significant complications include cement (PMMA) pulmonary embolism, spinal cord compression from cement leakage into the canal or foramen, radiculopathy, adjacent-level vertebral fracture, and infection. Each represents a distinct ICD-10-CM diagnosis code for subsequent encounter documentation and may require additional procedure coding if surgical intervention becomes necessary.

Sources & references

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

Mira AI Scribe

When documenting a vertebroplasty encounter, Mira's scribe layer will prompt for the following to support clean claim submission: 1. PROCEDURE TYPE: Confirm whether the procedure was vertebroplasty (direct cement injection, no balloon) or kyphoplasty (balloon cavity creation preceding cement). This distinction determines the CPT family: 22510–22512 for vertebroplasty, 22513–22515 for kyphoplasty. 2. VERTEBRAL LEVEL(S): Capture each treated level explicitly (e.g., T12, L1). The primary-level code (22510 thoracic/lumbar or 22510 cervical) plus the add-on code (22511 for each additional thoracic/lumbar level) must reflect documented levels. Do not append modifier 51 to add-on codes. 3. IMAGING GUIDANCE MODALITY: State whether fluoroscopy or CT was used. Note that under CMS all-inclusive payment policy, guidance (72291/72292) is bundled—do not generate a separate imaging line unless a non-Medicare payer's policy explicitly permits it. 4. CLINICAL INDICATION: Link fracture etiology clearly. For osteoporotic fractures, document both the osteoporosis code (e.g., M80.08XA) and the compression fracture code. For neoplasm-related fractures, document the primary malignancy and the pathologic fracture code. Traumatic fractures are non-covered under Medicare—flag for ABN workflow. 5. BONE BIOPSY: If a biopsy was taken at the same vertebral level, it is integral and should not generate a separate code. If biopsy was at a different anatomical site in the same session, Mira will auto-append modifier XS and populate item 19 with the biopsy site. 6. CONSERVATIVE THERAPY FAILURE: Document the duration and nature of prior medical management (minimum 4–6 weeks) to satisfy LCD medical necessity criteria.

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Related terms

Kyphoplasty Clinical

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.

Pathologic fracture Clinical

A pathologic fracture is a bone break that occurs through an area weakened by an underlying disease process—such as osteoporosis, a neoplasm, or a bone cyst—rather than by an acute high-energy force. The weakened bone fails under stress that would not break a normal, healthy bone.

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.

Add-on code Coding

An add-on code (AOC) is a CPT or HCPCS code that describes a service performed alongside a primary procedure by the same clinician during the same session—it cannot be billed alone and is only payable when an appropriate primary code is also reported.