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

Percutaneous vertebral augmentation (vertebroplasty or kyphoplasty) is covered for patients with imaging-confirmed acute/subacute vertebral compression fractures who are symptomatic (hospitalized with NRS/VAS ≥8 or non-hospitalized with NRS/VAS ≥5 despite optimal non-surgical care) and who meet pain-trajectory and imaging/functional criteria (worsening pain or NRS/VAS ≥5 plus ≥2 of: >25% height loss, kyphotic deformity, RDQ >17). Coverage is also allowed for osteolytic vertebral metastatic disease or myeloma with intractable pain unresponsive to medical therapy. Absolute contraindications include pain not due to the identified VCF, active infection (osteomyelitis/discitis), and pregnancy; several relative contraindications (e.g., allergy to cement, uncorrected coagulopathy, spinal instability, neurologic compromise, >3 fractures) must be considered and documented.

"Documented acute or subacute vertebral compression fracture (VCF) on imaging."