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

Percutaneous vertebroplasty (PVP) and percutaneous vertebral augmentation (PVA/kyphoplasty) are covered for acute or subacute osteoporotic VCFs (T1–L5) documented by MRI or bone-scan/SPECT/CT when patients have significant pain (hospitalized NRS/VAS ≥8 or non-hospitalized NRS/VAS ≥5 despite optimal non-surgical care) and either worsening pain or, if stable with NRS/VAS ≥5, two or more adverse structural/functional findings (vertebral height loss >25%, kyphotic deformity, RDQ >17). Coverage also includes osteolytic malignant vertebral fractures from metastasis or myeloma meeting the stated criteria; exclusions include active infection, pregnancy, allergy to cement/contrast, uncorrected coagulopathy, spinal instability or neurologic compromise, and treating more than three levels in one procedure. Required documentation includes appropriate advanced imaging, objective pain scores, records of non-surgical management, radiographic justification, absence of infection/pregnancy/coagulation issues, and referral for bone density evaluation and osteoporosis treatment.