Refer to the payer policy for ICD-10-CM diagnosis codes that most accurately describes the patients condition and are required to support medical necessity in your region. Multiple diagnosis codes may be required. The Local Coverage Decisions (LCDs) for Medicare Administrator Contractors are available on the Centers for Medicare and Medicaid Services (CMS) website at https://www.cms.gov/medicare/coverage/determinationprocess/lcds.html

 

Vertebroplasty and Vertebral Augmentation Procedures

 

Physician  Payment
Vertebroplasty and Vertebral Augmentation Procedures

CPT Code

Description

Non-facility (office)*

Facility*

22510

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic

$1,804.18

$468.68

22511

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral

$1,785.56

$440.03

22512

each additional cervicothoracic or lumbosacral

$1,000.73

$218.05

22513

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

$7,504.15

$560.71

22514

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar

$7,495.91

$522.73

22515

each additional thoracic or lumbar vertebral body

$4,541.90

$236.82

*Source: CY 2016 Medicare Physician Fee Schedule Final Rule.

 

Hospital Outpatient
Vertebroplasty and Vertebral Augmentation Procedures

CPT Code

Description

APC

CY 2016 Medicare*

22510

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic

5122

$2,395.59

22511

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral

5122

$2,395.59

22512

each additional cervicothoracic or lumbosacral

Packaged

22513

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

5124

$7,064.07

22514

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar

5124

$7,064.07

22515

each additional thoracic or lumbar vertebral body

Packaged

*Source: CY 2016 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Payment Systems Final Rule.

 

Ambulatory Surgery Center
Vertebroplasty and Vertebral Augmentation Procedures

CPT Code

Description

Status indicators

CY 2016 Medicare*

22510

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic

G2

$1,339.58

22511

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral

G2

$1,339.58

22512

each additional cervicothoracic or lumbosacral

N1

Packaged

22513

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic

G2

$3,532.70

22514

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar

G2

$3,532.70

22515

each additional thoracic or lumbar vertebral body

N1

Packaged

Status Indicators:

  • G2: Non-office based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
  • N1: Packaged service/item; no separate payment made.
*Source: CY 2016 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Payment Systems Final Rule.

Hospital Inpatient
Vertebroplasty and Vertebral Augmentation Procedures

ICD-10-PCS

Description

OPU33JZ

Supplement Cervical Vertebra with Synthetic Substitute, Percutaneous Approach

0PU43JZ

Supplement Thoracic Vertebra with Synthetic Substitute, Percutaneous Approach

0QU03JZ

Supplement Lumbar Vertebra with Synthetic Substitute, Percutaneous Approach

0QU13JZ

Supplement Sacrum with Synthetic Substitute, Percutaneous Approach

MS-DRG

Description

Estimated Base Payment*

515

Other musculoskeletal system & connective tissue O.R. procedures w/ MCC

$18,523

516

Other musculoskeletal system & connective tissue O.R. procedures w/ CC

$ 12,016

517

Other musculoskeletal system & connective tissue O.R. procedures w/o CC/MCC  

$10,299

*Source: FY 2016 Medicare Hospital Inpatient Prospective Payment System Final Rule.

 

Bone Tumor Radiofrequency Ablation Procedures

 

Physician Payment
Radiofrequency Ablation

CPT Code

Description

Non-facility (office)*

Facility*

20982

Ablation, therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency

$3,075.11

$395.18

*Source: CY 2016 Medicare Physician Fee Schedule Final Rule.

 

Hospital Outpatient
Radiofrequency Ablation

CPT Code

Description

APC

CY 2016 Medicare*

20982

Ablation, therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency

5122

$2,395.59

*Source: CY 2016 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Payment Systems Final Rule.

 

Ambulatory Surgery Center
Radiofrequency Ablation

CPT Code

Description

Status indicators

CY 2016 Medicare*

20982

Ablation, therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency

G2

$1,339.58

Status Indicators:

  • G2: Non-office based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
  • N1: Packaged service/item; no separate payment made.
*Source: CY 2016 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgery Center Payment Systems Final Rule.

 

Hospital Inpatient
Radiofrequency Ablation

ICD-10-PCS

Description

0P543ZZ

Destruction of Thoracic Vertebra, Percutaneous Approach

0Q503ZZ

Destruction of Lumbar Vertebra, Percutaneous Approach

MS-DRG

Description

Estimated Base Payment*

495

Local Excision and Removal Internal Fixation Devices Except Hip and Femur with MCC

$17,707.14

496

Local Excision and Removal Internal Fixation Devices Except Hip and Femur w/ CC

$10,248.66

497

Local Excision and Removal Internal Fixation Devices Except Hip and Femur w/o CC/MCC

$7,303.44

*Source: FY 2016 Medicare Hospital Inpatient Prospective Payment System Final Rule.

 


Disclaimer:  Providers are ultimately responsible for determining the appropriate codes, coverage, and payment for individual patients. DFINE does not guarantee third party coverage or payment for DFINE products. DFINE makes no representation or warranty regarding the completeness, accuracy or timeliness of information as payer policies are complex and change frequently. DFINE recommends contacting the third party or governmental payer to verify correct coverage, coding and billing for medical procedures and products.