Braven Health Vertebroplasty/Kyphoplasty prior authorization requirements (2026)
What Braven Health generally requires to approve Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515), for medicare_advantage plans. Yes. Braven Health generally requires prior authorization for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
Medical-necessity criteria Braven Health generally applies
Prior authorization via TurningPoint Spine Services (Vertebral Augmentation — Kyphoplasty/Vertebroplasty, CPT 22510-22515). Refractory-pain / fracture criteria in the TurningPoint policy library. [NEEDS CLINICAL SPOT-CHECK]
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Vertebroplasty/Kyphoplasty. Confirm the covered diagnosis list against the current Braven Health policy.
How to submit
- Method: TurningPoint (Availity / portal / 1-833-436-4083)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — Surgical & Implantable Device Management Program — Spine Services (procedure-code list incl. laminectomy/discectomy, cervical & lumbar disc replacement, vertebral augmentation).View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does Braven Health require prior authorization for Vertebroplasty/Kyphoplasty?
Yes. Braven Health generally requires prior authorization for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
What does Braven Health require to approve Vertebroplasty/Kyphoplasty?
Prior authorization via TurningPoint Spine Services (Vertebral Augmentation — Kyphoplasty/Vertebroplasty, CPT 22510-22515). Refractory-pain / fracture criteria in the TurningPoint policy library. [NEEDS CLINICAL SPOT-CHECK] Always confirm against the current Braven Health policy.
How long does a Braven Health prior authorization take?
Turnaround varies by plan and submission method. Check the Braven Health portal for current timeframes.
Submitting Vertebroplasty/Kyphoplasty to Braven Health?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.