CPT 22513 · Vertebral Augmentation · BCBS Illinois
Kyphoplasty — Thoracic (1st level) at BCBS Illinois.
How BCBS Illinois approaches CPT 22513 (Kyphoplasty — Thoracic (1st level)) for prior-authorization review: at last review on 2024-10-28, the policy covers this code with prior authorization required.
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MSK03-1125.1-UC0126Criteria summary
High-level themes from the BCBS Illinois policy of record for CPT 22513. 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 BCBS Illinois criteria.
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