Medicare Payments for Kyphoplasty



I read that Medicare is allowing over $7600 for 22523. This is more than I get for a craniotomy for aneurysm clipping. Is this a mistake by Medicare?


No. Actually, Medicare’s guidelines changed in 2012 to allow these codes procedure to be performed in office setting (place of service 11). Therefore, if performed in POS 11 then the physician incurs the practice expense for the procedure which is why the reimbursement is higher than when performed in a facility setting (where the physician does not incur practice expense).

The 2012 facility (F) and non-facility (NF) RVUs are listed below compared to the 2011 RVUs. Notice that in 2011 the non-facility RVUs are “not applicable” which means there was no payment when performed in the non-facility setting (or POS 11).

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