Vertebral Augmentation Coverage

The International Pain and Spine Intervention Society has joined with the Multisociety Pain Workgroup (MPW) in submitting comments to several commercial payers requesting an adjustment of the medical necessity language within vertebral augmentation coverage policies.

The letters present evidence that precluding vertebral augmentation procedures in patients with acute osteoporotic vertebral compression fractures will negatively impact patient outcomes and providers’ ability to deliver evidence-based, appropriate spinal care to all patients. The societies are requesting that payers bring their coverage criteria in line with those applied to Medicare patients, for whom the procedure may be deemed medically necessary before completing 6 weeks of non-surgical management.

Aetna

Carelon

Cohere

Evicore

HCSC

Humana

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