Oxford Health Plans Vertebroplasty/Kyphoplasty prior authorization requirements (2026)
What Oxford Health Plans generally requires to approve Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515), for commercial plans. Yes. Oxford Health Plans generally requires prior authorization for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
Medical-necessity criteria Oxford Health Plans generally applies
Prior authorization required (22510-22515; 22513/22514 also site-of-service reviewed). Proven/medically necessary for pain causing functional impairment within 4 months of pain onset that has failed Optimal Medical Therapy, for defined indications (osteoporotic VCF, steroid-induced fracture, osteolytic metastasis, multiple myeloma, aggressive hemangioma, osteonecrosis/Kummel). CT/MRI must exclude other pain generators; collapse to under one-third original height, cord compression, or a healed/asymptomatic VCF are exclusions. Submit via the UnitedHealthcare Provider Portal.
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 Oxford Health Plans policy.
How to submit
- Method: UHC Provider Portal
- Portal: UnitedHealthcare Provider Portal
Sources & verification
- BindingSource — UHC Commercial/Exchange Medical Policy — Percutaneous Vertebroplasty and Kyphoplasty (2026T0581Q) · effective 2026-03-01.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 Oxford Health Plans require prior authorization for Vertebroplasty/Kyphoplasty?
Yes. Oxford Health Plans generally requires prior authorization for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
What does Oxford Health Plans require to approve Vertebroplasty/Kyphoplasty?
Prior authorization required (22510-22515; 22513/22514 also site-of-service reviewed). Proven/medically necessary for pain causing functional impairment within 4 months of pain onset that has failed Optimal Medical Therapy, for defined indications (osteoporotic VCF, steroid-induced fracture, osteolytic metastasis, multiple myeloma, aggressive hemangioma, osteonecrosis/Kummel). CT/MRI must exclude … Always confirm against the current Oxford Health Plans policy.
How long does a Oxford Health Plans prior authorization take?
Turnaround varies by plan and submission method. Check the Oxford Health Plans portal for current timeframes.
Submitting Vertebroplasty/Kyphoplasty to Oxford Health Plans?
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.