Novitas Comments re Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130) due 2/27/21

Novitas Comments re Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (DL35130) due 2/27/21

View the article here. A Synopsis of Changes is below. 

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Synopsis of Changes

CHANGESFIELDS CHANGED
In the Covered Indications section - T5-L5 was changed to T1-L5 based on symptom onset, and documented by advanced imaging demonstrating bone marrow edema. Removed “confirmed by recent (within 30 days)”. These changes were made based on Subject Matter Expert (SME) and Stakeholder input.

In the Limitations section – added active surgical site infection under Absolute contraindication. Deleted “greater than three vertebral fractures” from Absolute contraindication. Added “greater than three vertebral fractures per procedure” as a Relative contraindication.

In the Summary of Evidence section – added a summary of the evidence to support changes made.

In the Analysis of Evidence section – added an analysis of the evidence.

In the Associated Information section – changed the wording from “Please refer to the Local Coverage Article: Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A57752) for documentation requirements that apply to the reasonable and necessary provisions outlined in this LCD” to “Please refer to the Local Coverage Article: Billing and Coding: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (A57752) for documentation and utilization requirements as applicable.
Coverage Indications Limitations and/or Medical Necessity
Associated Information
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