Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine

This policy addresses minimally invasive vertebral augmentation procedures—primarily percutaneous vertebroplasty and kyphoplasty (balloon, radiofrequency, and mechanical techniques)—for symptomatic osteoporotic vertebral compression fractures and for painful osteolytic spinal lesions such as metastatic disease, multiple myeloma, vertebral hemangioma, and eosinophilic granuloma. Coverage generally requires imaging confirmation and failure of conservative management (typically ≥6 weeks) or severe acute symptoms (hospitalization/impairment of ambulation), and excludes acute traumatic fractures or cases with unsafe anatomy (e.g., burst/retropulsed fragments, spinal stenosis >20%, vertebral collapse to less than one‑third height or vertebral plana); several procedures—including percutaneous sacroplasty, radiofrequency kyphoplasty and many mechanical devices—are considered experimental/unproven or not covered for many indications.

"Coverage section addresses percutaneous vertebroplasty and sacroplasty for vertebral fractures and osteolytic spinal lesions (specific clinical criteria not provided in this excerpt)"