C1062 Intravertebral Augmentation HCPCS Reimbursement | OpenPayer

Summary & Overview

HCPCS C1062: Intravertebral Body Fracture Augmentation with Implant

HCPCS Level II code C1062 represents intravertebral body fracture augmentation using an implant such as metal or polymer. The code captures a targeted spine procedure used to stabilize vertebral body fractures and support structural integrity following trauma, osteoporotic collapse, or other vertebral compromise. Nationally, procedures captured by this code are relevant due to an aging population, rising rates of vertebral fragility fractures, and ongoing technology adoption in spine stabilization.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how the service is categorized clinically, common sites of service, and typical billing considerations. The publication also provides benchmarks and coverage patterns where available, notes of recent policy activity affecting device-based vertebral augmentation, and clinical context for when implant-based augmentation is performed versus alternative vertebral procedures.

This summary equips payers, providers, and policy analysts with concise context for C1062, highlighting its clinical purpose, typical care settings, and the principal payers whose coverage and coding rules are commonly applicable at the national level. Data not available in the input is noted where specific payer policies, utilization data, or associated ICD-10 mappings would normally appear.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC1062HCPCS Level IIspine surgeryvertebral augmentationimplantfracture stabilizationambulatory surgeryhospital outpatientmedical billing

Billing Code Overview

HCPCS Level II code C1062 describes intravertebral body fracture augmentation with implant (e.g., metal, polymer). This procedure involves insertion of an internal implant into a vertebral body to stabilize or augment an intravertebral fracture.

Service Type: Fracture augmentation with implant

Typical Site of Service: Hospital inpatient or outpatient surgical setting, ambulatory surgical center, or specialized spine surgery center

Clinical & Coding Specifications

Clinical Context

A 72-year-old female with osteoporosis presents with acute severe mid-thoracic back pain after a minor ground-level fall. Imaging (plain radiographs and MRI) demonstrates an acute compression fracture of the T8 vertebral body with height loss and persistent pain despite conservative therapy (analgesics, bracing, and physical therapy) for 4–6 weeks. The interventional spine team recommends intravertebral body fracture augmentation with implantation of an expandable metallic/polymer implant to restore vertebral height and stabilize the fracture.

Workflow:

Pre-procedure: history and physical, informed consent, review of imaging (radiographs, CT/MRI), medication reconciliation, preoperative labs as indicated, and anesthesia evaluation for monitored anesthesia care or general anesthesia.
Procedure: under fluoroscopic guidance, percutaneous transpedicular or parapedicular access to the fractured vertebral body; dilation and insertion of an intravertebral implant (eg, metallic or polymer spacer) with or without adjunctive bone cement augmentation; intra-procedural fluoroscopic confirmation of implant position and vertebral height restoration.
Post-procedure: observation in recovery, post-procedure radiographs or CT to document device placement, pain reassessment, discharge planning with outpatient follow-up and activity restrictions. Typical sites of service include inpatient hospital, outpatient hospital (ambulatory surgery center), or freestanding ambulatory surgery center depending on patient comorbidity and payor rules.

Coding Specifications

Modifier	Description

HCPCS C1052: Hemostatic Agent, Gastrointestinal, Topical

Taxonomy Code	Specialty	Notes
`207XS0122X`	Interventional Pain Medicine	Commonly performs percutaneous vertebral augmentation and implant placement.
`207L00000X`	Orthopedic Surgery	Spine surgeons often perform fracture augmentation with implants.
`2084P0800X`	Physical Medicine & Rehabilitation (PM&R)	Physiatrists with spine intervention training perform vertebral augmentation procedures.
`2084S0102X`	Pain Medicine (Anesthesiology)	Anesthesiologists or pain specialists provide monitored anesthesia care and perform spine interventions.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M80.08XA`	Age-related osteoporosis with current pathologic fracture, vertebra(e), initial encounter for fracture	Osteoporotic vertebral compression fractures commonly indicate vertebral augmentation with implant for stabilization and pain control.
`S22.00XA`	Fracture of thoracic vertebra, unspecified, initial encounter for closed fracture	Traumatic thoracic vertebral fractures with persistent pain or instability may be treated with intravertebral augmentation and implant placement.
`S32.0XXA`	Fracture of lumbar vertebra, initial encounter for closed fracture	Lumbar compression fractures are another anatomic indication for intravertebral implant augmentation.
`M48.56`	Collapsed vertebra, not elsewhere classified	Describes vertebral body collapse from degenerative or osteoporotic causes where augmentation and implant insertion may restore height.
`M51.36`	Other intervertebral disc degeneration, lumbar region	Secondary degenerative changes may coexist; augmentation may be considered when collapse causes structural pain.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`22520`	Arthrodesis, anterior or anterolateral approach, thoracic; single level	May be performed for unstable compression fractures when vertebral augmentation is insufficient; alternative surgical stabilization in the workflow.
`22521`	Arthrodesis, anterior or anterolateral approach, thoracic; each additional vertebral segment	Used when multi-level fusion is required following unstable fractures or failed augmentation.
`22842`	Posterior segmental instrumentation (eg, pedicle fixation), 3 to 6 vertebral segments	May be performed in conjunction with open surgical stabilization when augmentation with an intravertebral implant is not appropriate.
`22513`	Percutaneous vertebral augmentation (eg, kyphoplasty), 1 vertebral level	Commonly performed alternative or adjunct procedure; cement augmentation may be coded in addition to implant placement if payer allows and codes are distinct.
`76942`	Ultrasonic guidance for needle placement	Ancillary guidance code sometimes used for percutaneous spinal access when ultrasound is used as adjunct to fluoroscopy.

`22`	Increased procedural services	Use when the procedure required substantially greater work than typical (document reasons: extensive additional time, complexity).
`23`	Unusual anesthesia	Use when general anesthesia is medically necessary for an otherwise non-anesthetized procedure (document rationale).
`52`	Reduced services	Use when the procedure is partially reduced or not completed as planned but still performed.
`53`	Discontinued procedure	Use when the procedure is started but terminated due to extenuating circumstances or patient safety.
`54`	Surgical care only	Use when the surgeon provides only the surgical procedure and the postoperative care is transferred to another provider.
`55`	Postoperative management only	Use when the provider bills only postoperative care for the procedure.
`56`	Preoperative management only	Use when the provider bills only preoperative care for the procedure.
`62`	Two surgeons	Use when two surgeons work together as primary surgeons performing distinct portions of a complex procedure.
`AS`	Ambulatory surgical center facility	Use to indicate services provided in an ambulatory surgical center setting when required by payor.
`FY`	Bilateral procedure (HCPCS-specific modifier for some devices)	Use when bilateral devices or implants are placed and payer requires reporting (use if applicable to bilateral vertebral augmentation).

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