Summary & Overview
CPT 22514: Lumbar Vertebral Augmentation (Kyphoplasty)
CPT code 22514 represents a percutaneous vertebral augmentation procedure of the lumbar spine — typically kyphoplasty — used to stabilize and restore height in vertebral compression fractures. Performed under imaging guidance, the procedure can include fracture reduction and bone biopsy when clinically indicated. Nationally, this code is significant because it captures a high-cost, image-guided surgical intervention with implications for hospital and ambulatory surgery center utilization, device supply chain, and postprocedure care pathways.
Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage policies and prior authorization requirements vary across these payers, affecting access and site-of-service decisions.
Readers will find a concise clinical and billing context for CPT code 22514, including service definitions, typical settings of care, and the kinds of benchmarks and policy topics that commonly accompany vertebral augmentation coding (utilization rates, payer coverage criteria, and coding specificity for imaging-guided spinal procedures). Data not available in the input will be noted where applicable. The publication aims to inform coding professionals, hospital administrators, and clinicians about the procedural scope and payer considerations tied to this code.
Billing Code Overview
CPT code 22514 describes a percutaneous vertebral augmentation of the lumbar spine, commonly performed as kyphoplasty to treat vertebral compression fractures. The procedure may include fracture reduction and bone biopsy for diagnostic purposes and is performed under imaging guidance.
-
Service type: Surgical percutaneous spinal augmentation (kyphoplasty) with optional fracture reduction and diagnostic bone biopsy
-
Typical site of service: Hospital outpatient department or ambulatory surgery center, under fluoroscopic or other imaging guidance
Clinical & Coding Specifications
Clinical Context
A 74-year-old woman with a history of osteoporosis presents to the emergency department with acute onset severe low back pain after a ground‑level fall. Imaging (CT and fluoroscopic guidance) confirms an acute compression fracture of the L2 vertebral body with >20% loss of vertebral height and persistent pain despite conservative management (analgesics, bracing, and limited activity). After multidisciplinary review, the interventional spine team schedules a percutaneous vertebral augmentation (kyphoplasty) under monitored anesthesia care in an ambulatory surgery center. The provider performs image‑guided percutaneous access to the lumbar vertebral body, reduction of the compression deformity with a balloon tamp, biopsy of bone if indicated to exclude occult malignancy, and bone cement augmentation to restore vertebral height and stabilize the fracture. The procedure uses continuous fluoroscopy for guidance, sterile technique, and local anesthesia with sedation; typical intraoperative documentation includes indication, levels treated, cement type and volume, reduction maneuvers, any biopsy specimens sent to pathology, estimated blood loss, and post‑procedure neurovascular status. Postoperative workflow includes brief observation in recovery, pain reassessment, ambulation assessment, discharge instructions, and scheduling of follow‑up imaging and clinic visit.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician’s professional component separate from technical imaging or facility resources. |