Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

This billing and coding guidance states that percutaneous vertebral augmentation (PVA) for vertebral compression fracture (VCF) is covered when medical necessity is documented and the service complies with LCD L38201. Claims must include a valid, specific ICD-10-CM diagnosis code and, when applicable, the referring/ordering physician’s name and NPI; venography performed during the operative session is bundled and must not be billed separately. Procedure codes may be subject to NCCI or OPPS edits, and the medical record must contain relevant history, physical exam, and diagnostic test results to support medical necessity.

"Percutaneous vertebral augmentation (PVA) for a vertebral compression fracture (VCF) is covered when medical necessity is documented and the service is consistent with the Local Coverage Determinat..."

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