CPT 22515Surgery

Perq vertebral augmentation

CPT 22515 covers percutaneous vertebral augmentation, a minimally invasive procedure where a physician injects bone cement into a fractured or collapsed vertebra 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

$2,656.62

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

PE RVU (NF)

77.33

MP RVU

0.8

Total RVU

82.13

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Verify place of service code accuracy: POS 22 (outpatient hospital) yields $209.61 while POS 11 (office) or POS 24 (ASC) yields $2,656.62
Impact: Incorrect POS coding creates $2,447 payment differential and may trigger audit for site-of-service manipulation
Bill each additional vertebral level with 22515 appended with modifier 59 or XU, not add-on code 22515
Impact: Failure to use distinct procedural modifier results in automatic denial of subsequent levels, losing approximately $1,300+ per additional level
Separately report imaging guidance (77002 for fluoroscopy or 77012 for CT) as these are not bundled per NCCI edits
Impact: Adds approximately $50-150 per case; commonly overlooked revenue opportunity
Document time interval from fracture to procedure and failure of conservative management for minimum 2-3 weeks to establish medical necessity
Impact: Prevents LCD denials; procedures performed within 48-72 hours of fracture have 60% higher denial rate without acute trauma documentation
When performing multiple levels, sequence codes from highest to lowest RVU value and append modifiers only to lower-value codes
Impact: Ensures maximum reimbursement under multiple procedure payment reduction (MPPR) rules; first level pays 100%, subsequent levels typically 50%
Report moderate sedation separately with 99152-99153 if provided by same physician, or 99155-99157 if by different qualified provider
Impact: Adds $100-200 per case; sedation is not included in 22515 base code as of 2017 CPT changes

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 22515?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

What is the Medicare reimbursement rate for CPT 22515 in 2025?

Medicare pays $2,656.62 for CPT 22515 in non-facility settings (office, ASC) and $209.61 in facility settings (hospital outpatient) based on the 2025 national average. The significant difference reflects that the non-facility rate includes practice expense for equipment, supplies, and staff, while the facility rate covers only physician work when the hospital provides infrastructure.

How many vertebral levels does CPT 22515 cover?

CPT 22515 covers percutaneous augmentation of one vertebral body only. Each additional vertebral level requires reporting 22515 again with modifier 59 or XU appended to subsequent levels. There is no separate add-on code for additional levels; you report the same code multiple times with appropriate modifiers.

Can CPT 22515 be billed bilaterally with modifier 50?

No, modifier 50 should not be used with CPT 22515. The code describes augmentation of a vertebral body, and bilateral transpedicular approaches to the same vertebra are considered part of the single procedure. Modifier 50 will result in denial as the code is inherently unilateral by vertebral level, not by approach side.

What documentation is required to support medical necessity for CPT 22515?

Required documentation includes imaging (MRI or bone scan) confirming acute vertebral compression fracture, pain severity scores typically >6/10, evidence of failed conservative treatment for 2-3 weeks (unless contraindicated for acute trauma or pathologic fracture), specific vertebral level identification, and clinical notes explaining why augmentation is medically necessary. Most Medicare LCDs require this timeline and documentation to avoid denial.

Is imaging guidance included in CPT 22515 or billed separately?

Imaging guidance is billed separately. CPT 22515 does not include radiologic supervision and interpretation. Report 77002 for fluoroscopic guidance or 77012 for CT guidance in addition to 22515. These codes are not bundled per NCCI edits and represent additional reimbursement of approximately $50-150 depending on the imaging modality used.

What are the RVU values for CPT 22515 in 2025?

CPT 22515 has total RVUs of 82.13 in 2025, consisting of 4.0 work RVUs, 77.33 non-facility practice expense RVUs (1.68 facility PE RVUs), and 0.8 malpractice RVUs. The high non-facility PE RVU reflects the significant equipment and supply costs for bone cement, delivery systems, and imaging equipment required when performed in office settings.

How should multiple level vertebral augmentations be coded?

Report CPT 22515 for the first level without a modifier. For each additional vertebral level, report 22515 again with modifier 59 (or XU for distinct procedural service) appended. List codes in descending RVU order since all levels have the same RVU value. Be aware that multiple procedure payment reduction (MPPR) typically reduces payment for subsequent levels to approximately 50% of the primary procedure rate.