CMM-607: Primary Vertebral Augmentation (Percutaneous Vertebroplasty/Kyphoplasty) and Sacroplasty

Percutaneous vertebral augmentation (vertebroplasty/kyphoplasty) is considered medically necessary only for prophylactic use to facilitate fusion (≤2 levels T5–L5), malignant vertebral destruction with concordant imaging and significant pain, and select non‑malignant T5–L5 compression fractures; sacroplasty/coccygeoplasty, cervical/T1–T4 levels, prophylactic osteoporosis treatment, non‑painful hemangiomas, non‑FDA materials/devices (and specified procedures like radiofrequency kyphoplasty, spinoplasty, vertebral body stenting) and multiple clinical contraindications are excluded. Key requirements include concordant imaging and documentation of significant daily pain/functional impairment, limits to ≤2 treated levels per date of service, enrollment in an osteoporosis program for osteoporotic fractures, and for subacute non‑malignant fractures documented trials of both 4 weeks of prescription analgesics/steroids/NSAIDs and 4 weeks of provider‑directed exercise (unless contraindicated), with urgent/emergent exceptions allowed with appropriate documentation.