Percutaneous Vertebroplasty, Kyphoplasty, Sacroplasty - Medicare Advantage

This Humana Medicare Advantage medical coverage policy defers to applicable CMS guidance and MAC LCDs for percutaneous vertebroplasty/kyphoplasty. Osteoporotic vertebral compression fractures are covered per CMS/LCD guidance in all jurisdictions; malignant and traumatic vertebral fractures in jurisdictions without LCD guidance are evaluated against the criteria in LCD L38213. Sacroplasty (CPT Category III 0200T/0201T) is not considered medically reasonable and necessary in any jurisdiction.

"Please refer to the above CMS guidance for information specific to percutaneous vertebroplasty/ kyphoplasty (22510, 22511, 22512, 22513, 22514, 22515, C7507, C7508) for osteoporotic vertebral compr..."

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