CPT Code 22513

CPT code 22513 is for percutaneous vertebral augmentation, a procedure to stabilize spinal fractures.

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What is CPT Code 22513

CPT code 22513 is for a procedure called percutaneous vertebral augmentation. This is a minimally invasive treatment used to stabilize a fractured vertebra in the spine, often due to osteoporosis or cancer. The procedure involves injecting a special cement-like material into the fractured bone to relieve pain and restore mobility.

Does CPT 22513 Need a Modifier?

When billing for CPT code 22513 (Percutaneous vertebral augmentation, including cavity creation, using mechanical device (e.g., kyphoplasty), one vertebral body, unilateral or bilateral cannulation (e.g., kyphoplasty); thoracic), the following modifiers may be applicable:

1. Modifier 50 - Bilateral Procedure: Used if the procedure is performed on both sides of the body.

2. Modifier 51 - Multiple Procedures: Applied when multiple procedures are performed during the same surgical session.

3. Modifier 52 - Reduced Services: Used if the procedure is partially reduced or eliminated at the physician's discretion.

4. Modifier 59 - Distinct Procedural Service: Indicates that the procedure is distinct or independent from other services performed on the same day.

5. Modifier 76 - Repeat Procedure by Same Physician: Used if the same procedure is repeated by the same physician.

6. Modifier 77 - Repeat Procedure by Another Physician: Applied if the same procedure is repeated by a different physician.

7. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: Used if the patient returns to the operating room for a related procedure during the postoperative period.

8. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: Indicates that the procedure is unrelated to the original procedure and performed during the postoperative period.

9. Modifier LT - Left Side: Used to specify that the procedure was performed on the left side of the body.

10. Modifier RT - Right Side: Used to specify that the procedure was performed on the right side of the body.

11. Modifier XS - Separate Structure: Indicates that a service is distinct because it was performed on a separate organ/structure.

12. Modifier XE - Separate Encounter: Used to indicate that a service is distinct because it was performed during a separate encounter.

13. Modifier XP - Separate Practitioner: Indicates that a service is distinct because it was performed by a different practitioner.

14. Modifier XU - Unusual Non-Overlapping Service: Used to indicate that a service is distinct because it does not overlap usual components of the main service.

These modifiers help provide additional information about the procedure performed and ensure accurate billing and reimbursement. Always verify payer-specific guidelines as they may have unique requirements for modifier usage.

CPT Code 22513 Medicare Reimbursement

Medicare does provide reimbursement for CPT code 22513, which pertains to percutaneous vertebral augmentation, including cavity creation using mechanical devices and bone cement for the thoracic vertebral body. The reimbursement amount can vary based on several factors, including geographic location and specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 22513 is approximately $1,200. However, it is essential to verify the exact reimbursement rate with your local MAC, as rates are subject to change and may differ based on regional adjustments and other considerations.

Are You Being Underpaid for 22513 CPT Code?

Discover how MD Clarity's RevFind software can meticulously analyze your contracts and pinpoint underpayments down to the CPT code level, including specific codes like 22513 for percutaneous vertebral augmentation. Ensure you're receiving the full reimbursement you deserve from each payer. Schedule a demo today to see RevFind in action and protect your revenue.

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