LCD Reference Article Response To Comments Article

Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

A59138

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A59138
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)
Article Type
Response to Comments
Original Effective Date
08/21/2022
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

The comment period for the Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) DL38737 Local Coverage Determination (LCD) began on 3/31/22 and ended on 5/14/22. The notice period for L38737 begins on 7/7/22 and will become effective on 8/21/22.

The title of the LCD was revised from Percutaneous Vertebral Augmentation (PVA) for Osteoporotic Vertebral Compression Fracture (VCF) to Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF)

The comment below was received from the provider community.

Response To Comments

Number Comment Response
1

Palmetto GBA recently retired Local Coverage Article (LCA) A56819. This LCA has been replaced by Palmetto GBA LCA A58275 and Palmetto GBA Local Coverage Determination (LCD) L38737.

Local Coverage Article A58275 is highly restrictive and inadequate in its publication of ICD-10 Codes that Support Medical Necessity. Only four ICD-10 codes are listed, all of which relate to osteoporotic fractures only, M80.08XA, M80.08XS, M80.88XA and M80.88XA. These fail to encompass other common etiologies of vertebral compression fractures, including malignancy, endocrine disease, drug inducement, and injury or consequences of external causes.

Additionally, please consider the designation of “fragility fractures” as the diagnosis of osteoporosis can only be made in retrospect after the patient has undergone a DEXA scan.

In particular, by omitting coverage for malignant fractures, the patients with cancer in our region may endure unnecessary pain and suffering related to malignancy-related VCFs. PVA has been well established to be safe and effective in the treatment of malignancy-related VCFs through randomized, controlled trials, such as the CAFE Trial (Berenson, et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. 2011. The Lancet Oncology).

We are requesting Palmetto GBA to retroactively modify, update or replace LCD L38737 and LCA A58275 in order to sufficiently allow coverage for all VCF medically necessary conditions requiring PVA, specifically in the case of malignant compression fractures.

Thank you for your time and consideration.

There were multiple similarly worded comment letters which are summarized above. Please review the most recent LCD and associated article which adds evidence and codes for malignancy related fractures. In regard to other indications there was no evidence supplied with your request therefore we cannot modify the LCD and associated article. Please consider requesting an LCD reconsideration by supplying the required information per the LCD reconsideration process article available on Palmetto GBA’s website.

N/A

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
07/01/2022 08/21/2022 - N/A Currently in Effect You are here

Keywords

N/A