Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

This billing and coding policy for percutaneous vertebral augmentation (PVA) requires reporting PVA on a per-vertebral-body basis using CPT 22513 (thoracic), 22514 (lumbar), and 22515 for each additional level, with coverage contingent on meeting the medical necessity criteria in LCD L38213. Bone biopsy and venography performed during the operative session are considered integral and not separately payable (unless biopsy is at a separate site/session with appropriate modifiers and documentation); assistant-at-surgery payments are statutorily restricted and procedure codes remain subject to NCCI/OPPS edits. Claims must include a valid, specific ICD-10-CM diagnosis code and required documentation (history, exam, prior conservative treatment, imaging guidance, referring physician NPI when applicable) available for contractor review.

"Report percutaneous vertebral augmentation (PVA) including cavity creation on a per-vertebral-body basis using CPT 22513 for thoracic, CPT 22514 for lumbar, and CPT 22515 for each additional thorac..."