The Vertebroplasty, Vertebral Augmentation; Percutaneous Local Coverage Determination (LCD) has gone through the comment period and is now finalized. All comments have been reviewed and responses have been completed. The comment/response document can be found in the LCD under "Advisory Committee Notes." The effective date is September 6, 2011, on which date the automated edits become active.
The notice period for this LCD is starting July 22, 2011 and ends September 6, 2011. The notice period gives time for each provider to review the LCD and educate appropriate staff on proper coding and coverage for this service.
LCD Summary:
Medical record review has demonstrated widespread, fundamental errors in patient selection, technical performance of procedures, pre and post procedural assessment of patients, and the common absence of follow-up of any kind - which initiated our coverage review and resulted in this draft LCD. Among our clinical concerns are the failure to attempt appropriate conservative management for a reasonable - or any - period of time; failure to inform patients of alternative treatments and potential complications of the injection procedures; treatment of an inappropriate number of levels; treatment during an active infection; treatment in the face of other unaddressed pain generators both spinal and in other body areas; treatment when other procedures are indicated or performed; failure to adequately follow patients for a reasonable period of time; and a disturbing incidence of complications. These concerns resulted in an extensive literature review, consequent proposal to non-cover any vertebral augmentation procedure, and ultimately, resulted in this policy.
The following CPT codes are listed in the LCD.
CPT Codes: 22520
Description: PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; THORACIC
CPT Codes: 22521
Description: PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; LUMBAR
CPT Codes: 22522
Description: PERCUTANEOUS VERTEBROPLASTY, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT Codes: 22523
Description: PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); THORACIC
CPT Codes: 22524
Description: PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); LUMBAR
CPT Codes: 22525
Description: PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION (EG, KYPHOPLASTY); EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
CPT Codes: 72291
Description: RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL AUGMENTATION, OR SACRAL AUGMENTATION (SACROPLASTY), INCLUDING CAVITY CREATION, PER VERTEBRAL BODY OR SACRUM; UNDER FLUOROSCOPIC GUIDANCE
CPT Codes: 72292
Description: RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL AUGMENTATION, OR SACRAL AUGMENTATION (SACROPLASTY), INCLUDING CAVITY CREATION, PER VERTEBRAL BODY OR SACRUM; UNDER CT GUIDANCE
The following procedure codes are non-covered, regardless of diagnosis.
CPT Codes: 0200T
Description: PERCUTANEOUS SACRAL AUGMENTATION (SACROPLASTY), UNILATERAL INJECTION(S), INCLUDING THE USE OF A BALLOON OR MECHANICAL DEVICE, WHEN USED, 1 OR MORE NEEDLES
CPT Codes: 0201T
Description: PERCUTANEOUS SACRAL AUGMENTATION (SACROPLASTY), BILATERAL INJECTIONS, INCLUDING THE USE OF A BALLOON OR MECHANICAL DEVICE, WHEN USED, 2 OR MORE NEEDLES
Locate the LCD on the NAS website https://www.noridianmedicare.com.
22 Hover over "Medicare Part A" and select your state from the list
22 The End User Agreement for Providers will appear if you have not recently visited the website. Select "Accept" (if necessary).
22 Hover over "LCDs/Coverage/MR," "Local Coverage Determinations (LCDs)," and select "Future LCDs."
22 In the table titled "Future LCDs Available on the CMS Medicare Coverage Database, " select your state.
22 Select LCD type "Future Effective Documents."
For questions regarding the location of this information, contact the Provider Contact Center (PCC) at: 877-908-8437.
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