About this policy
The information in this article contains coding guidelines that complement the Local Coverage Determination (LCD) for Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L38201) . Coding Information: Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. No separate payment for venography performed during the operative session may be allowed and it should not be separately billed. The patient's medical record must contain documentation that fully supports the medical necessity for services included within the related LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 22510 | HCPCS | Covered |
| 22511 | HCPCS | Covered |
| 22512 | HCPCS | Covered |
| 22513 | HCPCS | Covered |
| 22514 | HCPCS | Covered |
| 22515 | HCPCS | Covered |
| C41.2 | ICD10CM | Covered |
| C79.51 | ICD10CM | Covered |
| C90.00 | ICD10CM | Covered |
| C90.02 | ICD10CM | Covered |
| M80.08XA | ICD10CM | Covered |
| M80.88XA | ICD10CM | Covered |