Summary & Overview
HCPCS C7504: Percutaneous Vertebroplasty, Cervicothoracic/Lumbosacral
HCPCS Level II code C7504 represents percutaneous vertebroplasty procedures for the first cervicothoracic vertebral body and any additional cervicothoracic or lumbosacral levels, inclusive of imaging guidance and bone biopsy when performed. This code captures image-guided vertebral augmentation interventions used to stabilize fractured or painful vertebral bodies and is nationally relevant due to increasing utilization of minimally invasive spinal procedures and associated cost and quality oversight. Key payers in the national landscape include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a focused overview of clinical scope and coding context, payer coverage patterns, common billing modifiers, and benchmarking considerations relevant to hospital outpatient departments and ambulatory surgery centers. The publication highlights reimbursement and utilization benchmarks, coding nuances for multi-level procedures, and policy updates that affect prior authorization and documentation requirements. Clinical context covers indications for vertebroplasty and the inclusion of imaging guidance and bone biopsy in the service definition. Data not available in the input is noted explicitly where applicable.
Billing Code Overview
HCPCS Level II code C7504 describes percutaneous vertebroplasties, including bone biopsies when performed, for the first cervicothoracic and any additional cervicothoracic or lumbosacral vertebral bodies. The procedure is reported for unilateral or bilateral injection and is inclusive of all imaging guidance used during the intervention.
Service type: Image-guided percutaneous spinal vertebroplasty/vertebral augmentation, which may include bone biopsy when performed.
Typical site of service: Hospital outpatient department or ambulatory surgery center, and other settings where image-guided spinal interventional procedures are performed.
Clinical & Coding Specifications
Clinical Context
A 72-year-old female with a history of osteoporosis presents with sudden onset severe mid-thoracic back pain after minimal trauma. Imaging (thoracic spine radiographs and MRI) demonstrates an acute compression fracture of the T7 vertebral body with persistent pain despite conservative management. The interventional radiology team schedules a percutaneous vertebroplasty to stabilize the fracture and reduce pain. On the day of service, the patient is placed prone on the fluoroscopy table, monitored per procedural sedation protocols, and local anesthesia is administered. Using fluoroscopic and/or CT guidance, a transpedicular approach is used to access the affected T7 vertebral body. Polymethylmethacrylate cement is injected unilaterally into the first treated cervicothoracic or thoracic vertebral body; cement distribution is confirmed with real-time imaging. A bone biopsy is not performed in this case. The patient is observed in the recovery area and discharged same day with post-procedure activity and analgesic instructions.
This procedure is commonly performed by interventional radiologists, spine surgeons, or pain medicine specialists in an ambulatory surgery center, hospital outpatient department, or inpatient setting when clinically indicated. Documentation should include indication, vertebral level(s) treated, approach (unilateral or bilateral), imaging guidance used, type and volume of cement, peri-procedural monitoring and anesthesia, and any biopsies if performed. Billing uses HCPCS Level II code C7504 for the first cervicothoracic or any additional cervicothoracic or lumbosacral vertebral bodies, inclusive of imaging guidance.
Coding Specifications
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