CPT Code 22515

CPT code 22515 is for percutaneous vertebral augmentation, a minimally invasive procedure to stabilize spinal fractures.

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What is CPT Code 22515

CPT code 22515 is for a procedure called percutaneous vertebral augmentation. This is a minimally invasive treatment used to stabilize a fractured vertebra, often due to osteoporosis or cancer. The procedure involves injecting a special cement-like material into the damaged vertebra to relieve pain and restore stability.

Does CPT 22515 Need a Modifier?

For CPT code 22515 (Percutaneous vertebral augmentation), 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 when 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 when 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 when 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 AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: Applied when these healthcare professionals assist in the surgery.

12. Modifier GC - This Service Has Been Performed in Part by a Resident Under the Direction of a Teaching Physician: Used in teaching settings where a resident is involved in the procedure.

Each modifier serves a specific purpose and should be used appropriately to ensure accurate billing and reimbursement.

CPT Code 22515 Medicare Reimbursement

Medicare does reimburse CPT code 22515, which pertains to percutaneous vertebral augmentation, including cavity creation using mechanical devices and bone cement (e.g., kyphoplasty), one vertebral body, thoracic. The reimbursement amount can vary based on geographic location and specific Medicare Administrative Contractor (MAC) policies. As of the latest available data, the national average reimbursement for CPT code 22515 is approximately $1,200. However, it is crucial to verify the exact reimbursement rate with the relevant MAC and consider any updates to the Medicare Physician Fee Schedule (MPFS) for the most accurate and current information.

Are You Being Underpaid for 22515 CPT Code?

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