CPT 22513Surgery

Perq vertebral augmentation

CPT 22513 covers percutaneous vertebral augmentation, a minimally invasive procedure where a physician injects bone cement into fractured or weakened vertebrae through a needle to stabilize the spine. This is commonly performed for compression fractures caused by osteoporosis or cancer.

Showing rates for

National Average

Base Medicare rate

$5,206.49

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

8.65

PE RVU (NF)

150.73

MP RVU

1.58

Total RVU

160.96

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Verify place of service code accuracy—POS 22 (outpatient hospital) versus POS 24 (ASC) versus POS 11 (office)
Impact: Incorrect POS can trigger $4,713.21 reimbursement variance between facility and non-facility rates; office-based procedures require significant equipment investment but yield 10.5x higher reimbursement
Bill 22514 for each additional vertebral level beyond the first; never bill 22513 multiple times on same date
Impact: 22514 adds approximately $266-$389 per additional level; incorrect use of 22513 for subsequent levels results in automatic denials
Document fracture age and medical necessity including failed conservative therapy duration (typically 4-6 weeks required)
Impact: Lack of conservative treatment documentation accounts for 35-40% of denials; prior authorization requirements vary by payer but Medicare requires documented failed conservative care
Submit imaging reports (MRI, CT, or bone scan) showing bone marrow edema to prove fracture acuity
Impact: Acute fractures with marrow edema have 90%+ approval rates versus 60% for chronic fractures without edema; payers frequently deny treatment of healed fractures
Use diagnosis codes M80.08XA (osteoporosis with pathological fracture) or M84.48XA (pathological fracture) with seventh character 'A' for acute encounter
Impact: Incorrect seventh character extension or non-specific fracture codes trigger medical review and 15-20 day payment delays
Separately bill for imaging guidance (77002 or 77003) as these are not bundled with 22513
Fluoroscopic guidance adds $50-$75 per claim; failure to bill separately leaves money on table in approximately 25% of claims

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 22513 in 2025?

Medicare pays $5,206.49 for CPT 22513 in non-facility settings and $493.28 in facility settings under the 2025 Physician Fee Schedule. The non-facility rate applies when performed in an office-based setting where the practice owns the equipment, while the facility rate applies in hospital outpatient departments or ASCs.

How many RVUs is CPT code 22513 worth?

CPT 22513 has a total of 160.96 RVUs for 2025, consisting of 8.65 work RVUs, 150.73 practice expense RVUs (non-facility), 5.02 practice expense RVUs (facility), and 1.58 malpractice RVUs. The high PE RVU reflects the significant equipment and supply costs for vertebral augmentation procedures.

Can CPT 22513 be billed multiple times on the same date of service?

No, CPT 22513 should only be billed once per date of service for the first vertebral level treated. For each additional vertebral level, use add-on code 22514. Billing 22513 multiple times will result in automatic denials and potential audit flags.

What modifiers are commonly used with CPT 22513?

Common modifiers include 59 (distinct procedural service) when unbundling is necessary, 76 (repeat procedure by same physician) for additional levels, and 51 (multiple procedures) when other distinct procedures are performed. RT/LT modifiers may be used for laterality documentation when relevant.

Does CPT 22513 require prior authorization from Medicare?

Traditional Medicare does not require prior authorization for 22513, but Medicare Advantage plans frequently do. Documentation of failed conservative therapy for 4-6 weeks, recent imaging showing acute fracture with bone marrow edema, and medical necessity is typically required for authorization approval.

What diagnosis codes are appropriate for billing CPT 22513?

Appropriate ICD-10 codes include M80.08XA (age-related osteoporosis with current pathological fracture of vertebra), M84.48XA (pathological fracture, other site), S22.0XXA (fracture of thoracic vertebra), and S32.0XXA (fracture of lumbar vertebra). The seventh character 'A' for initial encounter is critical for acute fracture treatment.

What is the difference between CPT 22513 and 22514?

CPT 22513 is the primary code for the first vertebral level treated during percutaneous vertebral augmentation, while 22514 is an add-on code for each additional level treated during the same session. 22514 cannot be billed alone and must always accompany 22513. Reimbursement for 22514 is significantly lower as it represents incremental work.