CPT 22525 · Vertebral Augmentation
Kyphoplasty — Additional (legacy)
Kyphoplasty, each additional vertebral body. (Legacy code — current equivalent 22515.)
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Rubrica tracks payor coverage for CPT 22525 (Kyphoplasty — Additional (legacy)) across 16 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 22525
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 |
| Allstate Auto / PIP | Covered | Prior auth |
| AmTrust Financial WC | Covered | Prior auth |
| Cigna Medicare / HealthSpring | Covered | Prior auth |
| Erie Insurance Auto / PIP | Covered | Prior auth |
| Geico Auto / PIP | Covered | Prior auth |
| Humana Medicare Advantage | Covered | Prior auth |
| Liberty Mutual / Helmsman WC | Covered | Prior auth |
| Molina Healthcare (Medicaid) | Covered | Prior auth |
| Nationwide Auto / PIP | Covered | Prior auth |
| Progressive Auto / PIP | Covered | Prior auth |
| Railroad Medicare (Palmetto GBA national) | Covered | Prior auth |
Coverage themes for CPT 22525
Common patterns across the 16 payors we track. Specific criteria per payor are available after sign-in.
Conservative care requirements vary by payor for 22525.
Imaging documentation requirements vary by payor.
Of the 16 payors with coverage records for CPT 22525, 9 require prior authorization, 7 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
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