CPT 22514Surgery

Perq vertebral augmentation

CPT 22514 covers percutaneous vertebral augmentation, a minimally invasive procedure where bone cement is injected into a fractured or weakened vertebra through a needle to stabilize the spine. This is commonly used to treat painful compression fractures caused by osteoporosis or cancer.

Showing rates for

National Average

Base Medicare rate

$5,182.23

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

7.99

PE RVU (NF)

150.75

MP RVU

1.47

Total RVU

160.21

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 (hospital outpatient) versus POS 24 (ASC) versus POS 11 (office) determines whether you receive $5,182.23 or $460.94
Impact: $4,721.29 difference (over 1,000%) between non-facility and facility rates makes this the single most important billing element
Bill 22515 for each additional thoracic or lumbar level treated in the same session—do not repeat 22514 for subsequent levels
Impact: Proper use of add-on code 22515 ensures full reimbursement for multilevel procedures while avoiding unbundling denials
Separately report imaging guidance codes 77001, 77002, or 77003 when performed and documented, as these are not bundled with 22514
Impact: Fluoroscopic or CT guidance adds approximately $50-150 to reimbursement when properly documented and reported
Document medical necessity including failure of conservative treatment (typically 4-6 weeks), acute or subacute fracture age (usually less than 12 months), and correlation between imaging and pain location
Impact: Strong medical necessity documentation reduces denial rate from approximately 15-20% to under 5% based on specialty society data
Report conscious sedation separately using 99151-99153 or anesthesia codes when provided by a different practitioner, ensuring documentation of start/stop times and monitoring
Impact: Conscious sedation codes can add $150-300 per procedure when separately documented and medically necessary
Verify LCD/NCD coverage requirements for your MAC including specific ICD-10 codes—M80.08XA (osteoporosis with fracture) typically covered, while prophylactic augmentation usually is not

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Frequently asked questions

What is the difference between CPT 22514 and 22515?

CPT 22514 is used for the first thoracic or lumbar vertebral level treated with percutaneous augmentation during a single session, reimbursed at $5,182.23 (non-facility). CPT 22515 is an add-on code used for each additional thoracic or lumbar level treated in the same session. You should never bill 22514 more than once per session—use 22515 for subsequent levels.

How much does Medicare pay for CPT code 22514 in 2025?

Medicare pays $5,182.23 for CPT 22514 when performed in a non-facility setting (physician office with owned equipment) and $460.94 when performed in a facility setting (hospital outpatient or ASC) based on the 2025 national average rates. The significant difference reflects the practice expense of owning and maintaining the equipment and facility.

Can CPT 22514 be billed bilaterally with modifier 50?

Bilateral modifier 50 is rarely applicable to 22514 because each vertebral body is a single midline structure, not a paired anatomical structure. If treating multiple vertebral levels, use 22514 for the first level and add-on code 22515 for each additional level rather than modifier 50.

What diagnosis codes are required for CPT 22514 to be covered?

Medicare typically covers 22514 for osteoporotic compression fractures (M80.08XA, M80.88XA), pathological fractures due to neoplastic disease (M84.58XA), and fractures due to multiple myeloma (C90.00). The fracture must usually be acute or subacute (typically less than 12 months old) with evidence of bone marrow edema on MRI. Prophylactic treatment or chronic fractures without edema are generally not covered.

How many vertebral levels can be treated and billed in one session?

There is no absolute Medicare limit on the number of levels that can be treated in one session, but medical necessity must support each level. Bill 22514 once for the first thoracic or lumbar level, then 22515 for each additional level. Most payers consider 2-3 levels per session medically reasonable, while 4 or more levels may trigger additional review requiring strong documentation of medical necessity.

Can imaging guidance be billed separately with CPT 22514?

Yes, fluoroscopic guidance (77002, 77003) or CT guidance (77012) can be billed separately with 22514 as these imaging codes are not bundled. Documentation must clearly show that imaging guidance was used for needle placement and cement injection monitoring. The imaging must be performed by the same physician or qualified practitioner and documented in the procedure report.

What is the global period for CPT 22514?

CPT 22514 has a 90-day global period, meaning routine follow-up care for 90 days after the procedure is included in the reimbursement. Any separately billable services during this period must be unrelated to the vertebral augmentation or represent treatment of complications. Use modifier 24 for unrelated E/M services or modifier 58 for staged or related procedures during the global period.