Mountain State Medical Policy Bulletin |
Section: | Surgery |
Number: | S-148 |
Topic: | Kyphoplasty |
Effective Date: | August 1, 2005 |
Issued Date: | August 1, 2005 |
Date Last Reviewed: | 06/2005 |
Indications and Limitations of Coverage
Kyphoplasty (S2362, S2363) is a procedure done percutaneously with use of an inflatable balloon bone tamp to help correct deformity of collapsed vertebral body and to create a controlled space into which bone cement is injected. This procedure is eligible when performed for any of these indications:
Kyphoplasty performed for any other indication(s) is considered not medically necessary, and therefore, is not covered. A participating, preferred, or network provider cannot bill the member for this denied service. Description Balloon kyphoplasty is the minimally invasive reduction and fixation of vertebral body compression fractures (VCF) designed to provide significant pain relief, fracture reduction and stabilization, restoration of vertebral height, and reduction of spinal deformity. Vertebral compression fracture (VCF) is the most common fracture caused by osteoporosis. Osteoporosis is recognized as one of the major public health problems facing postmenopausal women and aging individuals of both sexes. Historically, conventional methods of treatment for VCF have included bed rest, the use of narcotics, and braces. However, as an alternative to these conventional methods of treatment, a percutaneous procedure called kyphoplasty can be performed. |
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S2362 | S2363 |
PRN References |
National Blue Cross and Blue Shield Association TEC Assessment: Vol. 18, No. 1, 01/2000 |