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

Percutaneous vertebral augmentation (PVP or PKP) is covered for patients with imaging-confirmed acute/subacute vertebral compression fractures who meet symptom thresholds (hospitalized with NRS/VAS ≥8 or non-hospitalized with NRS/VAS ≥5 despite optimal non-surgical care) and either worsening pain or persistent NRS/VAS ≥5 plus at least two objective findings (height loss >25%, kyphotic deformity, or RDQ >17). All patients must be referred for BMD evaluation and receive osteoporosis education and instruction to participate in a prevention/treatment program; PVA is also covered for osteolytic vertebral metastatic disease or myeloma with intractable pain unresponsive to medical therapy. Coverage is excluded for absolute contraindications (pain not due to identified VCF, active infection, pregnancy) and limited by relative contraindications (e.g., allergy to cement, uncorrected coagulopathy, spinal instability, neurologic compromise, fracture retropulsion, or >3 vertebral fractures).