Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF)

PVA (percutaneous vertebroplasty or balloon kyphoplasty) is covered only for osteoporotic VCFs at T1–L5 and is excluded when due to non‑osteoporotic causes or when absolute contraindications exist (e.g., active infection/osteomyelitis, pregnancy, uncorrected coagulopathy, spinal instability, neurologic deficit or neural impingement, fracture retropulsion/canal compromise, allergy to cement/opacification agents) or relative contraindations apply (e.g., >3 fractures per procedure). Coverage requires ALL: acute (<6 weeks) or subacute (6–12 weeks) VCF proven by advanced imaging showing bone‑marrow edema or bone‑scan/SPECT uptake; specified symptom severity (hospitalized NRS/VAS ≥8 or non‑hospitalized NRS/VAS ≥5 despite optimal non‑surgical management with required worsening or structural/function criteria); referral for BMD evaluation/osteoporosis education and instruction to participate in a prevention/treatment program; and full documentation of exam, imaging, pain scores, NSM, contraindication exclusion, and timing.