Summary & Overview
HCPCS C7507: Percutaneous Vertebral Augmentation, Thoracic/Lumbar
HCPCS Level II code C7507 represents percutaneous vertebral augmentation procedures—such as kyphoplasty using a mechanical device—for the first thoracic vertebral body and any additional thoracic or lumbar vertebral bodies, inclusive of cavity creation, fracture reductions, bone biopsies when performed, and all imaging guidance. This code matters nationally as vertebral augmentation is a common intervention for vertebral compression fractures and related spine pathologies, with implications for hospital outpatient departments and ambulatory surgical centers.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarking context for coverage and reimbursement practices across major national payers, clinical scope and coding boundaries for percutaneous vertebral augmentation with mechanical devices, and notes on service settings and documentation elements that commonly affect claim processing. The publication outlines typical claim components and highlights areas where payers often require specific clinical justification.
This executive summary provides a concise national view: what the code covers clinically, where the service is typically delivered, which major payers are relevant, and the types of policy and billing issues that commonly arise for procedures reported with C7507. Data not available in the input is noted where applicable in the detailed sections.
Billing Code Overview
HCPCS Level II code C7507 describes percutaneous vertebral augmentations for the first thoracic vertebral body and any additional thoracic or lumbar vertebral bodies. The procedure includes cavity creation (such as kyphoplasty) using a mechanical device, and explicitly includes fracture reductions and bone biopsies when performed. The description covers both unilateral and bilateral cannulations and is inclusive of all imaging guidance used during the procedure.
Service Type: Percutaneous vertebral augmentation (kyphoplasty-style mechanical device) involving thoracic and/or lumbar vertebral bodies
Typical Site of Service: Hospital outpatient or ambulatory surgical center (ASC)
Clinical & Coding Specifications
Clinical Context
A 72-year-old female with known osteoporosis presents to the interventional spine clinic with acute worsening mid-back pain after a ground-level fall. Imaging (thoracic spine MRI and CT) demonstrates a painful acute compression fracture of the T8 vertebral body with height loss and bone marrow edema. Conservative management including analgesics and bracing provided inadequate relief over two weeks, and the patient remains functionally limited. The interventional radiology team schedules a percutaneous vertebral augmentation procedure using a mechanical device (kyphoplasty) to restore vertebral height and stabilize the fracture.
Pre-procedure workflow includes history and physical, review of imaging, informed consent, medication reconciliation (including anticoagulation management), and anesthesia evaluation. On the day of service, the patient is positioned prone in a fluoroscopy suite. Unilateral or bilateral transpedicular cannulation of the affected thoracic vertebral body is performed under image guidance. A cavity creation and balloon tamp are used to reduce fracture and create a void; polymethylmethacrylate (PMMA) cement is then injected to augment the vertebral body. Intra-procedural imaging monitors cement flow. Post-procedure the patient is observed for complications, pain relief is reassessed, and discharge instructions are provided. Typical site of service is an ambulatory surgical center or hospital outpatient department; inpatient performance occurs when medically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 |