In the absence of a National Policy and a Local Medical Review Policy, this carrier will be determining coverage case by case, based on Medicare's medical necessity and reasonableness criteria (similar to percutaneous vertebroplasty). Providers should submit claims with CPT code 22899 (unlisted procedure, spine) and state "Kyphoplasty" in Item 19 of Form CMS-1500 form or in its electronic equivalent. Radiological supervision and interpretation may be billed with CPT codes 76012 or 76013, as applicable. The surgical fee for this service is all-inclusive. Casting or the removal of bone to create a cavity for the insertion of the tamp, sometimes submitted as a bone biopsy, are not separately billable. The Global Period is ten days. Effective with November 1, 2003, the allowable amounts for this procedure will be increased to the following levels:

Thoracic: $628.19
Lumbar: $591.92
Each additional: $295.96

Please note that this treatment should only be used for vertebral compression fractures that meet the definition of medical necessity for percutaneous vertebroplasty and the coverage provisions as discussed in the Local Medical Review Policies of the respective states. Medicare coverage is based on both the FDA indications and the medical necessity for each vertebral body treated. The patient's medical record should reflect the indication for the procedure and contain a complete operative report.