CPT 22511 · Vertebral Augmentation · Wellpoint Maryland
Vertebroplasty — Lumbosacral (1st level) at Wellpoint Maryland.
How Wellpoint Maryland 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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Carelon Spine Surgery MSK03-1125.1-UC0126Criteria summary
High-level themes from the Wellpoint Maryland policy of record for CPT 22511. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Carelon Clinical Appropriateness Guidelines — Spine Surgery (Vertebroplasty/Kyphoplasty section)
See the full Wellpoint Maryland criteria.
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