# Vertebroplasty Kyphoplasty: Cost, Coverage, and What to Expect

Source: https://ourhealthnetwork.com/procedure-costs/vertebroplasty-kyphoplasty
Last reviewed: 2026-04-20
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays about $1,881 for the surgeon's fee for kyphoplasty or vertebroplasty, but the full bill with facility charges and devices typically lands between $15,000 and $30,000 on commercial insurance. Setting and number of spine levels drive most of the variation.

## What it is

Kyphoplasty and vertebroplasty are minimally invasive procedures that treat painful compression fractures in the spine. These fractures are small breaks in the vertebra that can cause sharp back pain and loss of height. Most cases happen in people with osteoporosis, cancer that has spread to the spine, or an injury from a fall.

In both procedures, a doctor uses a hollow needle guided by live X-ray to reach the broken vertebra. The doctor then injects bone cement to stabilize the fracture and ease pain. Kyphoplasty adds a small balloon step. The balloon is inflated inside the bone first to create a space and restore some height, then removed before the cement goes in. Vertebroplasty skips the balloon and injects cement directly.

- **Time in the procedure room:** 45 to 90 minutes for a single level, longer for multiple levels
- **Anesthesia:** local numbing plus IV sedation in most cases; general anesthesia is used selectively
- **Hospital stay:** outpatient in the large majority of cases; you go home the same day
- **Incisions:** two small needle punctures in the back, no stitches needed
- **Imaging:** continuous fluoroscopy or occasionally CT guidance during the procedure

The two billing variants on this page differ only by which part of the spine is treated. Code 22513 covers thoracic vertebrae in the mid-back. Code 22514 covers lumbar vertebrae in the lower back. A surgeon picks one based on where the fracture is, not based on cost or technique differences.

## When it is done

Compression fractures often heal on their own with rest, pain medicine, and bracing over six to eight weeks. Kyphoplasty and vertebroplasty are reserved for fractures that do not get better, or cases where the pain is severe enough that waiting is not practical.

Your doctor may recommend this procedure when:

1. Back pain from a confirmed compression fracture has not improved after four to six weeks of conservative care
2. The pain is severe enough to keep you from walking, sleeping, or living independently
3. Imaging (MRI or bone scan) shows the fracture is still active and producing pain
4. The fracture is caused by a tumor in the spine and pain control is urgent
5. You are losing height quickly or developing a forward spinal curve from multiple fractures
6. Strong pain medicines are causing side effects that are harming your recovery

Alternatives worth discussing include continued bracing, physical therapy, and osteoporosis medications like teriparatide or denosumab. Research on whether kyphoplasty outperforms sham procedures has been mixed, so a frank conversation about realistic pain relief is important before scheduling.

## What you pay

Your out-of-pocket cost depends heavily on your insurance type and whether the procedure is billed as outpatient or inpatient. Medicare generally pays 40 to 60 percent of what commercial insurers pay, so the numbers below split cleanly by coverage.

**If you are on Medicare:**

- Most kyphoplasty cases are outpatient and fall under Part B, which pays 80 percent after the annual deductible ($257 in 2025 figure); you are responsible for the remaining 20 percent
- If the procedure is inpatient (unusual), the Part A inpatient deductible applies ($1,676 in 2025 figure) and covers the facility side
- A Medigap or Medicare Advantage plan typically covers the 20 percent coinsurance, leaving you with little to no direct cost
- Expect the full Medicare allowed amount for the episode to run $4,000 to $8,000 per level

**If you have commercial insurance:**

- Total billed charges usually run $15,000 to $30,000 per vertebra treated
- Your out-of-pocket will depend on your deductible and coinsurance, typically landing between $1,500 and $6,000 for the episode
- Most plans cover kyphoplasty as medically necessary once conservative care has failed, but prior authorization is almost always required
- Watch for separate bills from the surgeon, facility, anesthesia, and radiologist; each can apply coinsurance separately

**If you are uninsured or paying cash:**

- Negotiated or bundled self-pay rates often land between $10,000 and $20,000 per level at ambulatory surgery centers
- Hospital outpatient departments charge more; always call billing and ask for the cash-pay discount before scheduling
- Many hospitals offer financial assistance or charity care for patients below roughly 300 percent of the federal poverty line
- If you pay cash, get the total price in writing before the procedure and ask whether imaging, device, and anesthesia are included

## Anatomy of the bill

A single kyphoplasty generates several separate bills, even though you are treated in one visit. Understanding the parts helps you check each one for errors and in-network status.

- **Surgeon or proceduralist fee:** Paid to the doctor who performs the cement injection. Medicare pays about $1,881 on average; commercial insurers often pay two to four times that.
- **Facility fee:** The biggest line item. Hospitals bill for the operating suite, staff, recovery, and disposable supplies. This typically runs $8,000 to $20,000 on a commercial gross charge.
- **Anesthesia:** Billed by an anesthesiologist or CRNA for sedation or general anesthesia. Usually $400 to $1,500 depending on time and provider type.
- **Bone cement and balloon device:** The kyphoplasty balloon kit and polymethylmethacrylate cement can account for $2,000 to $5,000 on the facility side and are usually bundled into the facility fee.
- **Imaging guidance:** Fluoroscopy is used throughout the case. When interventional radiology performs the procedure, this is bundled; when a separate radiologist reads follow-up films, a professional interpretation fee may apply.
- **Pre-op imaging and consults:** MRI or CT confirming the active fracture, plus any spine consultation visits, bill separately and often occur weeks before.
- **Post-op follow-up:** One or two follow-up visits are typically included in a global 90-day window, but imaging and physical therapy are billed separately.

## Cost by state

State-level Medicare payments shown in the data reflect the surgeon's fee only, not the full procedure cost. With that caveat, the range is striking. Minnesota has the lowest weighted physician payment at about $346; Alaska tops the list at roughly $5,203. Alaska's figure comes from just 14 services billed by a single provider and should not be treated as typical.

The states doing the most kyphoplasty volume are Florida (6,964 services), Mississippi (3,313), Oklahoma (3,060), Kansas (2,821), and Texas (2,633). Florida's high volume reflects its large older population, and its average physician payment of about $2,658 sits on the higher end. Mid-volume states like Tennessee, Indiana, and North Carolina cluster in the $1,700 to $2,000 range.

**Why costs vary by state:**

- **Medicare geographic indexes (GPCI):** Medicare adjusts physician fees by region to account for local cost of living and malpractice insurance
- **Commercial negotiation:** Private insurers in states with less hospital competition (rural Northeast, some Western states) often pay more per procedure
- **Billing setting mix:** States where more cases are done in physician-owned centers will show higher average physician payments, because the doctor is also paid for the supplies
- **State surprise-billing protections:** A handful of states cap out-of-network charges more tightly, which affects what you actually owe

## Office vs facility

The setting choice matters more for who gets paid than for your experience as a patient. The big gap in Medicare's data, where office-setting physician payments average $4,441 compared to about $426 in a facility, reflects billing structure, not ten times better care. In office-based procedures, the doctor also bills for the room, staff, and supplies. In a hospital, the hospital bills separately for those.

What matters for your out-of-pocket is the total episode cost, including the facility fee, which is almost always lower at an ambulatory surgery center than at a hospital outpatient department.

**Factors that favor one setting over the other:**

- **Hospital outpatient is better when:** you have significant heart or lung disease, are on blood thinners, or the procedure may convert to inpatient if complications arise
- **Ambulatory surgery center is better when:** you are otherwise healthy, the procedure is single-level, and you want a lower total bill
- **Office-based (physician-owned lab) is an option when:** the doctor is experienced with same-day sedation and the facility is credentialed; costs vary widely here
- **Always confirm the setting code on your estimate:** POS 22 (hospital outpatient) bills higher than POS 24 (ASC) or POS 11 (office) for most insurers

## Who performs the procedure

Kyphoplasty and vertebroplasty are performed by several different specialties, and which one you see often depends on how you entered the system. Orthopedic spine surgeons and neurosurgeons handle most cases that start in a surgical clinic. Interventional radiologists do a large share when the referral comes through the hospital or imaging center. Interventional pain specialists cover the remainder, especially in outpatient pain clinics.

**What to look for when choosing a specialist:**

- **Procedure volume:** Surgeons or radiologists doing at least 25 to 50 cases per year tend to have better outcomes and lower complication rates
- **Spine focus:** Within orthopedics, prefer a surgeon whose practice is primarily spine, not mixed general ortho
- **Fellowship training:** Look for fellowship training in interventional spine, spine surgery, or interventional radiology
- **Board certification:** Verify certification at certificationmatters.org or on the specialty board's site
- **Second opinion threshold:** If you are offered this for pain alone without evidence of an active fracture on MRI, get a second opinion
- **Multidisciplinary review:** Centers that review cases with both surgical and non-surgical teams typically offer more conservative options first

Note that diagnostic radiologists show up heavily in the billing data because they interpret the pre-op and post-op imaging, not because they personally perform the cement injection. When you see a bill from a diagnostic radiology group, that is usually for the imaging read.

## How to shop for the best price

Shopping for spine procedures takes effort, but the dollars are real. A few hours of phone calls can shift your out-of-pocket by thousands.

1. **Get a Good Faith Estimate in writing.** Federal law requires hospitals and self-pay providers to give you a written estimate at least three business days before a scheduled procedure. Ask for one that includes facility, surgeon, anesthesia, and device.
2. **Verify every billing party is in-network.** You can be treated at an in-network hospital but still get an out-of-network anesthesiologist, radiologist, or pathologist. Call each name on your estimate and confirm.
3. **Compare hospital outpatient versus ambulatory surgery center.** ASCs often run 30 to 50 percent less on the facility fee. Ask your surgeon whether they operate at both and what your cost would be at each.
4. **Ask about a bundled global fee.** Some practices offer a 90-day bundle that includes the procedure, all office visits, and one follow-up imaging study. A bundle can be easier to budget than itemized billing.
5. **Request charity care or a payment plan.** Most nonprofit hospitals have financial assistance policies reaching up to 300 or 400 percent of the federal poverty line. Apply before the procedure, not after the bill arrives.
6. **Get a second opinion on the indication.** Studies comparing kyphoplasty to sham procedures have not always shown a clear pain advantage. A second opinion from a non-proceduralist (like a physiatrist or pain specialist) is reasonable before committing.
7. **Confirm device brand and cement volume.** If cost is a concern, ask whether a mid-tier balloon kit is available; higher-tier devices do not always change outcomes.

Red flags: estimates that only cover the surgeon and leave off facility and anesthesia, vague language like 'additional fees may apply,' or a practice that will not commit to a cash-pay total in writing. If you cannot get a clear number, shop elsewhere.

## Surprise billing risks

Kyphoplasty is a high-risk procedure for unexpected bills because several providers usually bill separately, and not all of them work for the hospital directly. The anesthesiologist and radiologist are the most common sources.

**Most common surprise-billing sources for this procedure:**

- **Anesthesia:** The anesthesiologist or CRNA may be in a separate practice group, not employed by the hospital
- **Radiology professional fee:** Pre-op and post-op imaging interpretations bill separately and may be out-of-network
- **Pathology:** If tissue is sent for biopsy (common with suspected cancer), the pathologist may be out-of-network
- **Device or implant markup:** Hospitals sometimes bill the balloon and cement at a higher rate than your insurer's contracted price, triggering member balance disputes
- **Hospital transfer:** If a complication moves you from an ASC to a hospital, you may face new facility and physician charges

**If you get a surprise bill:**

- Do not pay until you have verified the charges against your explanation of benefits and your Good Faith Estimate
- Request an itemized bill with CPT codes, not just a summary
- The federal No Surprises Act (2022) protects you from most out-of-network bills for emergency care and for in-network facilities; file a dispute at cms.gov/nosurprises
- Contact your state insurance commissioner if the insurer refuses to correct an in-network coding error

## Total recovery cost

Most people go home the same day as the procedure. Pain relief, when it works, is often noticeable within 48 to 72 hours. You are usually back to light activities within a week and full activities within two to four weeks. Driving restrictions depend on sedation type and pain medication use.

**Add-on costs to budget for:**

- **Physical therapy:** $75 to $200 per session, often 6 to 12 sessions over 2 months if back-strengthening is recommended
- **Pain medication:** $20 to $100 for a short course; most patients stop opioids within a week
- **Back brace (if prescribed):** $150 to $600 depending on type; some are covered by insurance, others not
- **Osteoporosis medication:** If the fracture is osteoporotic, long-term treatment with bisphosphonates or injectable agents can run $20 to $3,000 per year depending on the drug
- **Bone density testing:** $100 to $300 for a DEXA scan, usually covered by Medicare and most commercial plans
- **Follow-up imaging:** One post-op X-ray or MRI; usually covered but may apply coinsurance
- **Time off work:** Typically 1 to 2 weeks for desk jobs, 4 to 6 weeks for physical work

Total episode cost, including follow-up care, usually runs 15 to 25 percent above the procedure sticker price. For a commercially insured patient paying $4,000 out-of-pocket for the procedure, plan on another $600 to $1,000 for physical therapy, medications, and incidental care over the next three months.

## Variants of this procedure

- Thoracic Kyphoplasty (Mid-Back)
- Lumbar Kyphoplasty (Lower Back)

## Frequently asked questions

### How much does kyphoplasty cost with insurance?

On commercial insurance, the full billed charge typically runs $15,000 to $30,000 per vertebra treated, but your out-of-pocket will usually be $1,500 to $6,000 once deductible and coinsurance are applied. Medicare beneficiaries with a Medigap plan often pay little to nothing. Always get a written Good Faith Estimate and verify every billing provider is in-network.

### Does Medicare cover kyphoplasty and vertebroplasty?

Yes, Medicare covers both procedures when medically necessary, which usually means a confirmed compression fracture, failed conservative care, and significant pain. Most cases are outpatient under Part B, which pays 80 percent after the $257 annual deductible (2025 figure). A Medigap or Medicare Advantage plan usually covers the remaining 20 percent.

### How long is recovery?

Most patients go home the same day. Significant pain relief, when it happens, appears within 2 to 3 days. Light activity resumes within a week, and full activity within 2 to 4 weeks. A small percentage of people do not get meaningful pain relief, which is one reason a careful pre-op discussion matters.

### Is kyphoplasty outpatient or does it require a hospital stay?

It is almost always outpatient. You arrive in the morning, the procedure takes 45 to 90 minutes, and you are typically discharged within a few hours. Inpatient admission is uncommon and usually reserved for patients with significant other health conditions or complications.

### What is the difference between kyphoplasty and vertebroplasty?

Vertebroplasty injects bone cement directly into the fractured vertebra. Kyphoplasty adds a balloon step first: a small balloon is inflated inside the bone to create a space and partially restore height, then removed before cement is injected. Kyphoplasty is more common today, but the underlying clinical benefit between the two is debated. The billing codes on this page (22513 and 22514) are both kyphoplasty codes; vertebroplasty uses different codes.

### How do I avoid a surprise bill?

Get a Good Faith Estimate three days before the procedure, and call the anesthesia group, radiology group, and any assistant surgeons to confirm they are in-network. After the procedure, review the itemized bill against your explanation of benefits before paying. If an out-of-network bill appears from an in-network facility, you are likely protected under the federal No Surprises Act and can dispute it at cms.gov/nosurprises.

### What is the cheapest way to get kyphoplasty?

Ambulatory surgery centers usually cost significantly less than hospital outpatient departments, often 30 to 50 percent less on the facility side. For cash-pay patients, call multiple centers and ask for a bundled self-pay price that includes surgeon, facility, anesthesia, and device. Hospital charity care can cover most of the bill for low-income patients.

### Where does this cost data come from?

Medicare figures come from the CMS Medicare Physician and Other Practitioners Public Use File, which reports average payment, charge, and volume by HCPCS code, provider, and state. Commercial and cash-pay ranges are based on published hospital charge data and reasonable estimates of insurer negotiation relative to Medicare. Actual costs vary by market and contract.

## Related

- [All procedure cost concepts](https://ourhealthnetwork.com/procedure-costs)
- [Find specialists who perform this procedure](https://ourhealthnetwork.com/find-doctors)
- [Insurance plans that cover this procedure](https://ourhealthnetwork.com/tools/insurance-matcher)