CPT 22521 · Vertebral Augmentation
Vertebroplasty — Lumbar (1st level)
Percutaneous vertebroplasty, 1 vertebral body; lumbar. (Legacy code — verify current coding.)
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Rubrica tracks payor coverage for CPT 22521 (Vertebroplasty — Lumbar (1st level)) across 31 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 22521
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna Medicare Advantage | Covered | Prior auth |
| Alabama Medicaid | Covered | Prior auth |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| California Medicaid (Medi-Cal) | Covered | Prior auth |
| Cigna Medicare / HealthSpring | Covered | Prior auth |
| Delaware Medicaid | Covered | Prior auth |
| Erie Insurance Auto / PIP | Covered | Prior auth |
| Florida Medicaid | Covered | Prior auth |
| Geico Auto / PIP | Covered | Prior auth |
| Georgia Medicaid | Covered | Prior auth |
| Humana Medicare Advantage | Covered | Prior auth |
Coverage themes for CPT 22521
Common patterns across the 31 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥6 weeks of conservative care before approving 22521.
3 of 31 payors require imaging concordance documentation.
Of the 31 payors with coverage records for CPT 22521, 24 require prior authorization, 7 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
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