What is CPT 22513 used for?

CPT 22513 is used by healthcare providers to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management. It represents Percutaneous Vertebral Augmentation Including Cavity Creation (Fracture Reduction And Bone Biopsy Included When Performed) Using Mechanical Device (Eg Kyphoplasty) 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance; Thoracic.

How can PayerPrice help with fee schedules?

PayerPrice helps users renegotiate managed care contracts by benchmarking current rates against market averages, prospect for new business using fee schedules, and integrate real-time payer data into workflows to automatically keep fee schedules up-to-date.

How can I find out the cost of a medical procedure?

The cost of a medical procedure can vary significantly based on your insurance plan, location, provider, and whether the provider is in-network. To get an estimate for a specific CPT code and your location, you can use tools like Payerprice, which offers a fee schedule lookup. Many hospitals and insurers also provide price transparency tools or guestimate services. Always check with your insurance provider to understand your specific benefits and out-of-pocket costs.

What is a CPT code and why is it important?

CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians and other healthcare providers to report medical, surgical, and diagnostic procedures and services to entities such as physicians, insurance companies, and accreditation organizations. They are crucial for consistent communication about medical services, billing, and determining reimbursement rates.

What's the difference between in-network and out-of-network costs?

In-network providers have a contract with your health insurance company to provide services at pre-negotiated rates. This generally results in lower out-of-pocket costs for you, as your plan covers a larger portion of the bill. Out-of-network providers do not have such contracts, meaning your insurance may cover less, or none, of the cost, leading to higher out-of-pocket expenses, including potentially higher deductibles and coinsurance.

Why do prices for the same procedure vary so much?

Prices for the same medical procedure can vary widely due to several factors. These include negotiated rates between providers and different insurance companies, geographic location, the type of facility (e.g., a hospital vs. an outpatient clinic), the provider's experience and reputation, and the varying charges across different healthcare systems. Price transparency initiatives aim to help consumers navigate these differences.

What resources are available to help me understand healthcare costs?

To understand healthcare costs, you can contact your health insurance company directly to inquire about your specific benefits, deductibles, and estimated costs for procedures. You can also reach out to the billing department of the healthcare provider you plan to visit for a good faith estimate. For looking up specific procedure costs using CPT codes for your location, Payerprice offers a valuable fee schedule lookup tool.

CPT 22513 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include Medicare & Medicaid rates (government-set reimbursement amounts), Private Insurance Rates (negotiated rates between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Perq Vertebral Augmentation, Percutaneous Vertebral Augmentation Including Cavity Creation Fracture Reduction And Bone Biopsy Included When Performed Using Mechanical Device Eg Kyphoplasty 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance Thoracic

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Musculoskeletal System
Common Place of Service	22 - On Campus Outpatient Hospital 11 - Office
Common Modifiers	None GC - Service performed by resident under supervision 59 - Distinct Procedural Service
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 22513
Medicaid Fee Schedule	View Medicaid rates for 22513

National average reimbursement for CPT 22513 by major payers:

$6,932.65

$9,325.24

$9,062.74

$1,523.07

Compare published rates across providers.

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CPT 22513

5 of 25 sample ratesHigher to lower in this preview

Methodist Healthcare System Of San Antonio, Ltd., L.L.P., Methodist Hospital
TXGeneral Acute Care HospitalNPI 1124074273Tax ID 74-2730328
$16,617.00Published rate
Ebd Bemc Burleson, LLC, Baylor Scott & White Emergency Hospital Grand Prairie
TXGeneral Acute Care HospitalNPI 1831629526Tax ID 36-4755936
$8,169.00Published rate
Nazareth Endoscopy Center, LLC
Nazareth Endoscopy Center LLC
PAAmbulatory Surgical Clinic/CenterNPI 1508400920Tax ID 82-4072967
$5,500.00Published rate
Maryam Rahbar, Md, Inc., Pacific Coast Spine Institute And Pain Center
Maryam Rahbar Md Inc
CAAmbulatory Surgical Clinic/CenterNPI 1245393602Tax ID 20-5511930
$2,700.00Published rate
Skin Cancer Treatment Center, L.L.C.
Skin Cancer Treatment Center LLC
MDAmbulatory Surgical Clinic/CenterNPI 1770753998Tax ID 26-2051034
$1,438.00Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 22513 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 22513 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 22513 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
22510-CPT	High	Perq Cervicothoracic Inject, Percutaneous Vertebroplasty Bone Biopsy Included When Performed 1 Vertebral Body Unilateral Or Bilateral Injection Inclusive Of All Imaging Guidance Cervicothoracic
22511-CPT	High	Perq Lumbosacral Injection, Percutaneous Vertebroplasty Bone Biopsy Included When Performed 1 Vertebral Body Unilateral Or Bilateral Injection Inclusive Of All Imaging Guidance Lumbosacral
22512-CPT	Moderate	Vertebroplasty Addl Inject, Percutaneous Vertebroplasty Bone Biopsy Included When Performed 1 Vertebral Body Unilateral Or Bilateral Injection Inclusive Of All Imaging Guidance Each Additional Cervicothoracic Or Lumbosacral Vertebral Body List Separately In Addition To Code For Primary Procedure
22513-CPT	High	Perq Vertebral Augmentation, Percutaneous Vertebral Augmentation Including Cavity Creation Fracture Reduction And Bone Biopsy Included When Performed Using Mechanical Device Eg Kyphoplasty 1 Vertebral Body Unilateral Or Bilateral Cannulation Inclusive Of All Imaging Guidance Thoracic

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 22513. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 22513 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 22513 Fee Schedule

Methodist Healthcare System Of San Antonio, Ltd., L.L.P., Methodist Hospital

Ebd Bemc Burleson, LLC, Baylor Scott & White Emergency Hospital Grand Prairie

Nazareth Endoscopy Center, LLC

Maryam Rahbar, Md, Inc., Pacific Coast Spine Institute And Pain Center

Skin Cancer Treatment Center, L.L.C.