Summary & Overview
CPT 22511: Lumbosacral Vertebroplasty, Vertebral Augmentation
CPT code 22511 denotes lumbosacral vertebroplasty, a percutaneous vertebral augmentation procedure using image-guided injection of bone cement into a fractured lower spinal vertebra. This code captures a commonly performed intervention for osteoporotic compression fractures and other vertebral body insufficiency when conservative care fails. Nationally, vertebroplasty is significant for its role in pain management, stabilization of the spine, and potential impact on utilization and procedure-site spending.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical context outlining indications and typical sites of service, billing considerations tied to the procedure setting, and a summary of common modifier usage when available. The publication also provides national benchmarking context, service-line placement for hospital and ambulatory settings, and notes on documentation elements tied to imaging guidance and potential biopsy content.
This summary equips administrators and billing professionals with the conceptual and operational understanding needed to code and classify lumbosacral vertebroplasty claims accurately and to compare coverage approaches across major national payers. Data not available in the input are identified where relevant.
Billing Code Overview
CPT code 22511 describes lumbosacral vertebroplasty, a minimally invasive surgical procedure to repair a fractured vertebra in the lower spine. The procedure typically involves percutaneous injection of bone cement into a compromised lumbosacral vertebral body under imaging guidance to stabilize the fracture, reduce pain, and restore structural integrity. A bone biopsy may be performed during the procedure for diagnostic evaluation when indicated.
Service type: Interventional spinal procedure / vertebral augmentation
Typical site of service: Hospital outpatient department, ambulatory surgery center, or specialized imaging-equipped procedural suite
Clinical & Coding Specifications
Clinical Context
A 76-year-old female with known osteoporosis presents with acute onset low back pain after a minor fall. Pain is severe, focal to the lower thoracic–lumbar junction radiating into the lumbosacral region, with limited mobility and inadequate pain control despite oral analgesics, bracing, and physical therapy over 2–4 weeks. Imaging (lumbar spine radiographs and MRI) demonstrates an acute osteoporotic compression fracture of L4 with height loss and bone edema consistent with a nonhealing painful fracture. The interventional spine specialist schedules a percutaneous lumbosacral vertebroplasty performed under fluoroscopic or CT guidance. The procedure includes conscious sedation or monitored anesthesia care, percutaneous transpedicular or parapedicular needle placement into the fractured vertebral body, optional bone biopsy if indicated for atypical imaging, and injection of polymethylmethacrylate cement to stabilize the fracture and reduce pain. Typical workflow: pre-procedure consent and evaluation, review of imaging and coagulation status, anesthesia and sterile preparation in an ambulatory surgery center or hospital procedure suite, image-guided needle placement and cement injection, immediate postprocedure imaging to confirm cement position, recovery monitoring for hemodynamic or neurologic changes, and discharge with specific activity and follow-up instructions. Typical site of service: ambulatory surgery center or hospital outpatient procedure unit; inpatient setting if medical comorbidity or observation required. Typical service type: image-guided percutaneous spinal procedure for stabilization and pain palliation of a lumbosacral vertebral compression fracture.
Coding Specifications
| Modifier | Description | When to Use |
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