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

Percutaneous vertebroplasty and percutaneous vertebral augmentation are covered for painful osteoporotic, malignant (osteolytic/metastatic or myeloma), and select traumatic vertebral compression fractures when patients meet clinical criteria (pain thresholds, failure of non-surgical management, or specific structural/functional findings such as >25% vertebral height loss or RDQ >17). Absolute contraindications include active infection and pain not attributable to the identified acute VCF, and several relative contraindications exist (eg, >3 levels per procedure, allergy to cement, uncorrected coagulopathy, pregnancy, spinal instability or neurologic compromise). Required documentation includes pain scores, evidence of NSM failure, imaging with measurements, functional scores, oncologic confirmation when applicable, level count and contraindication screening, and BMD/osteoporosis education as part of continuum of care.

"PVP or PVA is reasonable for painful, debilitating osteoporotic vertebral compression fractures (VCF) that have not responded to optimal non-surgical management (NSM) including medications and phys..."