CPT 22511 · Vertebral Augmentation · Priority Partners MCO
Vertebroplasty — Lumbosacral (1st level) at Priority Partners MCO.
How Priority Partners MCO approaches CPT 22511 (Vertebroplasty — Lumbosacral (1st level)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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eviCore CMM-607Criteria summary
High-level themes from the Priority Partners MCO policy of record for CPT 22511. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: JHHC / eviCore CMM-607 — Percutaneous Vertebral Augmentation (Priority Partners)
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