CG-SURG-07 Vertical Expandable Prosthetic Titanium Rib

This policy addresses the Vertical Expandable Prosthetic Titanium Rib (VEPTR) device, including implantation, expansion/lengthening, exchange/replacement, and rib-to-spine conversion. It is considered medically necessary when both criteria A and B are met, including that the patient has congenital, neuromuscular, idiopathic (infantile/juvenile/adolescent), or syndromic scoliosis; it is not medically necessary when these criteria are not met or for any other indications.

"Use of a vertical expandable prosthetic titanium rib device (including implantation, expansion [lengthening], exchange [replacement], or conversion [rib to spine]), is consideredmedically necessary..."

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