NY State Workers' Comp Vertebroplasty/Kyphoplasty prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515), for workers_comp plans. Yes. NY State Workers' Comp generally requires prior authorization for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
Medical-necessity criteria NY State Workers' Comp generally applies
Vertebroplasty/kyphoplasty requires prior authorization (on the 324.3 always-PA list; submit a PAR/Variance to the carrier via OnBoard). NY WC Mid and Low Back MTG (Section E.7): may be considered for select patients with vertebral body compression fractures associated with a subacute fracture and severe pain not responding to conservative measures; patients who fracture despite bisphosphonate therapy are particularly appropriate. No numeric pain cutoff or fixed conservative-care duration is specified in the MTG for augmentation.
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 NY State Workers' Comp policy.
How to submit
- Method: OnBoard PAR
- Portal: NY WCB OnBoard
Sources & verification
- BindingSource — NY WCB Mid and Low Back Injury Medical Treatment Guidelines (Section E.7) · effective 2022-05-02.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 NY State Workers' Comp require prior authorization for Vertebroplasty/Kyphoplasty?
Yes. NY State Workers' Comp generally requires prior authorization for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
What does NY State Workers' Comp require to approve Vertebroplasty/Kyphoplasty?
Vertebroplasty/kyphoplasty requires prior authorization (on the 324.3 always-PA list; submit a PAR/Variance to the carrier via OnBoard). NY WC Mid and Low Back MTG (Section E.7): may be considered for select patients with vertebral body compression fractures associated with a subacute fracture and severe pain not responding to conservative measures; patients who fracture despite bisphosphonate the… Always confirm against the current NY State Workers' Comp policy.
How long does a NY State Workers' Comp prior authorization take?
Turnaround varies by plan and submission method. Check the NY State Workers' Comp portal for current timeframes.
Submitting Vertebroplasty/Kyphoplasty to NY State Workers' Comp?
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.