TRICARE Vertebroplasty/Kyphoplasty prior authorization requirements (2026)
What TRICARE generally requires to approve Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515), for tricare plans. Prior authorization requirements vary by plan. Confirm with TRICARE for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
Medical-necessity criteria TRICARE generally applies
Covered (proven) per TRICARE Policy Manual Ch 4 Sec 6.1 (4.4): percutaneous vertebroplasty (22510-22512) and balloon kyphoplasty (22513-22515) are covered for painful osteolytic lesions and osteoporotic compression fractures refractory to conservative medical treatment. No fracture-acuity window or conservative-care duration is specified. Prior authorization is not stated in the manual — verify pre-authorization per regional contractor (Prime/Select admission rules differ).
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 TRICARE policy.
How to submit
- Method: Humana Military self-service
- Portal: Humana Military
Sources & verification
- BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 6.1 (Musculoskeletal, 4.4) · effective 2006-02-06.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 TRICARE require prior authorization for Vertebroplasty/Kyphoplasty?
Prior authorization requirements vary by plan. Confirm with TRICARE for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
What does TRICARE require to approve Vertebroplasty/Kyphoplasty?
Covered (proven) per TRICARE Policy Manual Ch 4 Sec 6.1 (4.4): percutaneous vertebroplasty (22510-22512) and balloon kyphoplasty (22513-22515) are covered for painful osteolytic lesions and osteoporotic compression fractures refractory to conservative medical treatment. No fracture-acuity window or conservative-care duration is specified. Prior authorization is not stated in the manual — verify pr… Always confirm against the current TRICARE policy.
How long does a TRICARE prior authorization take?
Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.
Submitting Vertebroplasty/Kyphoplasty to TRICARE?
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.