Medicare Contractor Proposes Changes to Coverage Policy for Percutaneous Vertebral Augmentation (PVA)

 The Medicare Administrative Contractor, National Government Services, Inc.(NGS), released a future Local Coverage Determination for PVA Osteoporotic Vertebral Compression Fractures effective December 1, 2019. The new coverage policy poses increased clinical inclusion and exclusion criteria required for billing and conflicts with language proposed by a Multisociety Pain Workgroup working with CMS on coverage policies. 

NGS is the Administrative Contractor for 10 states (listed in the future coverage policy) and therefore a change in policy impacts many Pain Medicine physicians. AAPM is drafting a response to the policy and encourages interested members to comment as individuals as well. The Coverage Policy can be accessed directly here. Scroll down the page to see the full policy and references. Please watch for updates in future editions of the AAPM E-News.

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American Academy of Pain Medicine