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

Billing for percutaneous vertebral augmentation (PVA) for vertebral compression fracture is governed by LCD L34976 and requires documentation that supports the ICD‑10 diagnosis and the CPT/HCPCS codes reported. Report PVA per vertebral body (CPT 22513 thoracic, 22514 lumbar, 22515 additional); payment is all‑inclusive (no separate payment for venography or integral bone biopsy), assistants at surgery are not payable, and specific modifiers (e.g., 59 or XS) are required only when a biopsy is a distinct separate-site/service and supported by documentation.

"Percutaneous vertebral augmentation (PVA) for vertebral compression fracture (VCF) is covered when it meets the reasonable and necessary clinical criteria specified in Local Coverage Determination ..."

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