UMR Vertebroplasty/Kyphoplasty prior authorization requirements (2026)
What UMR generally requires to approve Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515), for commercial plans. Prior authorization requirements vary by plan. Confirm with UMR for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
Medical-necessity criteria UMR generally applies
PLAN-SPECIFIC — PA applicability varies by employer plan; verify per-member via umr.com PA tool. [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 UMR policy.
How to submit
- Method: UMR provider portal (per-member PA tool)
- Portal: UMR
Sources & verification
- BindingSource — UMR Medical & Drug Policies (UHC-published) + UMR per-member Prior Authorization tool · effective 2025-11-01.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 UMR require prior authorization for Vertebroplasty/Kyphoplasty?
Prior authorization requirements vary by plan. Confirm with UMR for Vertebroplasty/Kyphoplasty (CPT 22510, 22511, 22512, 22513, 22514, 22515).
What does UMR require to approve Vertebroplasty/Kyphoplasty?
PLAN-SPECIFIC — PA applicability varies by employer plan; verify per-member via umr.com PA tool. [NEEDS CLINICAL SPOT-CHECK] Always confirm against the current UMR policy.
How long does a UMR prior authorization take?
Turnaround varies by plan and submission method. Check the UMR portal for current timeframes.
Submitting Vertebroplasty/Kyphoplasty to UMR?
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.