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Official Description

Percutaneous vertebral augmentations, first thoracic and any additional thoracic or lumbar vertebral bodies, including cavity creations (fracture reductions and bone biopsies included when performed) using mechanical device (e.g., kyphoplasty), unilateral or bilateral cannulations, inclusive of all imaging guidance
Short Descr Perq thor&lumb vert aug
Coverage Carrier Priced
Pricing Indicator(s) 11 – Physician Fee Schedule - Price established using national RVUs
MPI A – Not applicable, as HCPCS priced under one methodology
ASC Payment Group Code YY – 1/01/2023
Processing Note THESE CODES ARE USED ONLY UNDER THE ASC PAYMENT SYSTEM. REFER TO THE 2023 OPPS/ASC FINAL RULE AND THE DISCUSSION ON THE ASC SPECIAL PAYMENT POLICY FOR OPPS COMPLEXITY-ADJUSTED C-APCs FOR MORE INFORMATION.
BETOS P3D – Major procedure, orthopedic - other
TOS Code(s) 2 – Surgery
Added Date 1/1/2023
APC Status Indicator Non-Covered Service, not paid under OPPS
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
MUE 1
MUE Not applicable/unspecified.
OTS Orthotic No
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
Date
Action
Notes
2025-01-01 Note Clerical change.
2023-01-01 Added Code added.
Code
Description
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