Percutaneous Vertebroplasty and Kyphoplasty – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers percutaneous vertebroplasty and kyphoplasty as medically necessary for symptomatic cervical/thoracic/lumbar vertebral compression fractures within 4 months of pain onset that have failed Optimal Medical Therapy when the diagnosis is one of: osteoporotic or steroid‑induced VCF, osteolytic metastatic disease, multiple myeloma, aggressive vertebral hemangioma, or unstable osteonecrosis‑related fracture, provided CT/MRI exclude other pain generators. Exclusions include spinal cord compression, significant vertebral collapse (<1/3 height), healed or asymptomatic fractures, sacral/coccygeal lesions, VCFs responding to conservative care, and other nonlisted indications; required documentation includes medical records and CT/MRI confirming diagnosis, symptom duration, failure of conservative/optimal therapy, and absence of contraindications.

"Percutaneous vertebroplasty and kyphoplasty are proven and medically necessary for treating pain causing Functional or Physical Impairment in cervical, thoracic, or lumbar vertebral bodies within 4..."