Summary & Overview
HCPCS C7505: Percutaneous Vertebroplasty, First Lumbosacral and Additional Levels
HCPCS Level II code C7505 represents percutaneous vertebroplasty of the first lumbosacral vertebral body and any additional cervicothoracic or lumbosacral levels, inclusive of bone biopsy when performed and all imaging guidance. This procedural code captures a commonly used, minimally invasive intervention for vertebral body stabilization and pain management. Nationally, accurate coding of vertebroplasty affects clinical documentation, payer coverage determinations, and facility billing for image-guided spinal interventions.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of the code’s clinical scope, typical sites of service, and the role of bundled imaging guidance in coding. The publication outlines benchmark elements relevant to facility and professional billing, summarizes common modifier usage patterns for related services, and highlights policy and coverage considerations that commonly affect reimbursement and prior authorization requirements. The report also situates C7505 within the broader set of spine intervention codes to aid coding accuracy and claim submission workflows.
Data not available in the input for certain fields is noted where applicable.
Billing Code Overview
HCPCS Level II code C7505 describes percutaneous vertebroplasty procedures involving the first lumbosacral vertebral body and any additional cervicothoracic or lumbosacral vertebral bodies. The descriptor includes bone biopsy when performed, and covers unilateral or bilateral injection techniques. The listing specifies that the code is inclusive of all imaging guidance, indicating that image-directed needle placement and fluoroscopic or CT guidance are part of the bundled service.
Service type: Minimally invasive spinal procedure; vertebroplasty with or without bone biopsy.
Typical site of service: Hospital outpatient departments, ambulatory surgery centers, and interventional radiology suites where percutaneous spinal procedures and imaging guidance are performed.
Clinical & Coding Specifications
Clinical Context
A 72-year-old female with osteoporosis presents with acute severe midline lower back pain after a minimal fall. Imaging (lumbar spine radiographs and MRI) identifies an acute compression fracture at L2 with persistent pain despite conservative therapy (analgesics, bracing, physical therapy) and progressive functional limitation. Interventional radiology is consulted for image-guided stabilization.
The patient is evaluated in the outpatient interventional suite or ambulatory surgery center. After informed consent and pre-procedure assessment (medication reconciliation, coagulation status, IV access), conscious sedation or monitored anesthesia care is provided. Under fluoroscopic or CT guidance, a percutaneous transpedicular approach to the L2 vertebral body is performed. Bone biopsy is obtained if indicated for atypical imaging or concern for malignancy. Polymethylmethacrylate (PMMA) cement is injected unilaterally into the affected lumbosacral vertebral body to restore mechanical stability and reduce pain. Procedure documentation includes vertebral level(s) treated, laterality (unilateral or bilateral), cement volume, imaging guidance modality, and any complications.
Typical site of service is an outpatient hospital interventional radiology suite, ambulatory surgery center, or hospital inpatient setting when medically necessary. The service type is a percutaneous vertebroplasty/vertebral augmentation procedure for a lumbosacral vertebral body, inclusive of imaging guidance and bone biopsy when performed. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
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